Diverticular Disease (2)

Question 1

What is it?

What are the 2 main factors for its formation?

How does it present?

Why must biopsies be taken before a diagnosis?

Answer 1

➊ Presence of diverticular (outpouchings of the mucosa and submucosa, typically affecting the sigmoid colon)

➋ • Raised intraluminal pressure due to Low fibre diet - Movement of these faeces requires a lot more muscular effort → Smooth muscle hypertrophy → Raised intraluminal pressure
• Areas of weakness in colonic wall - there are natural defects in the circular muscle layer where blood vessels pass through to supply the mucosal layer

➌ Mostly asymptomatic, but can have:
• Constipation
• LLQ pain
• PR bleeding

➍ Can mimic colorectal ca., therefore biopsies should be done to rule it out

Question 2

Diverticulitis:
How does it present?

What are its short-term complications?

What are its long-term complications?

Answer 2

➊ • LLQ pain and tenderness
• Diarrhoea
• Fever
• N+V

➋ • Abscess - Managed with bowel rest, Abx ± drainage
• Perforation - Presents peritonitic, and is a surgical emergency

➌ • Fistula - Most commonly colovesical, presenting with pneumaturia, faecaluria, and recurrent UTIs
• Stricture
• Large bowel obstruction

Question 3

Management:
What is the lifestyle change to make?

What is done in hospital for acute cases?

Answer 3

➊ High-fibre diet

➋ • NBM
• IV Abx and Fluids
• Analgesia
• Urgent investigations or surgery