Diverticular Disease Flashcards
What is diverticular disease?
Diverticular disease refers to abdominal outpouching along the wall of the intestinal colonic lumen.
Define diverticulosis.
Diverticulosis is the presence of multiple diverticula in the colon, which may or may not involve bleeding.
What is diverticulitis?
Diverticulitis is the infection of the diverticula.
Which colon areas are most commonly associated with pulsion diverticula?
The left and sigmoid colon.
List the risk factors for diverticulosis.
- Age 60+
- Low-fibre diet
- High fatty foods/red meat
- Chronic constipation
What causes diverticulitis?
Micro-perforations in the diverticula caused by increased pressure in the lumen, such as food impaction –> infection
What are common symptoms of diverticulosis?
- Asymptomatic
- Constipation
- Abdominal discomfort after meals
- Rectal bleeding
What are symptoms of acute diverticulitis?
- LLQ abdominal pain
- Distention
- Low-grade fever
- Nausea and vomiting
- Change in bowel habits
What are potential complications of diverticulosis?
- Diverticular bleeding
- Diverticulitis
What complications can arise from acute diverticulitis?
- Abscess
- Partial colonic obstruction
- Peritonitis
- Fistula
What is a colovesicular fistula?
A colovesicular fistula may form causing pneumaturia, dysuria, and fecaluria.
What imaging technique is used for diagnosing diverticulitis?
CT with contrast of the abdomen and pelvis.
Colonoscopy contraindicated in acute diverticulitis due to risk of perforation and peritonitis
Why is colonoscopy contraindicated in acute diverticulitis?
Due to the risk of perforation and peritonitis.
What is the initial management for unstable patients with acute diverticulitis?
ABCDE approach.
Investigation for a stable patients with diverticulitis?
- PR exam (palpable mass)
- Stool occult blood test
- Blood tests (leukocytes, CRP, lactate)
- Imaging (CT w/ contrast)
What is the medical management for uncomplicated diverticulitis?
- Supportive care
- Oral antibiotics (co-amoxiclav, ciprofloxacin + metronidazole)
- Analgesia
- Hydration
What is the medical management for complicated diverticulitis?
e.g. severe symptoms/unable to drink
IV antibiotics (piperacillin, tazobactam, meropenem).
What are the surgical indications for diverticulitis?
- Perforation
- Abscess
- Fistulae
- Obstruction
What surgical procedures can be performed for diverticulitis?
- Primary resection with anastomosis
- Hartmann’s procedure
What is the procedure for purulent peritonitis?
Laparoscopic peritoneal lavage.
