Diverticular Disease

Question 1

What is the difference between a true and a false diverticulum?

Answer 1

True - outpouching of the complete wall

False - outpouching composed of mucosa only - mucosa herniates through weakness in muscularis propria where perforating arteries enter

Question 2

Name a well known true diverticulum

Answer 2

Meckel’s

Question 3

Name 2 false diverticuli

Answer 3

Pharyngeal

Colonic

Question 4

What percentage of westerners have diverticulosis by age 60?

Answer 4

30%

Question 5

What sex is diverticular disease most common in?

Answer 5

Women

Question 6

Where are diverticuli most commonly located?

Answer 6

Sigmoid colon

Question 7

What is Saint’s triad?

Answer 7

Describes two other diseases that are likely if the other is found:

Hiatus hernia
Gallstones
Diverticular disease

Question 8

What might be lacking in the diet if diverticulum have formed?

Answer 8

Fibre

Question 9

What are the three main symptoms of diverticular disease?

Answer 9

Altered bowel habit +/- left sided colic (relieved by defaecation)
Nausea
Flatulence

Question 10

One conservative, medical and surgical treatment for diverticular disease?

Answer 10

Increase fibre intake
Mebeverine
Elective resection if chronic pain

Question 11

Hard stool can block diverticuli, especially in elderly patients causing…?

Answer 11

Diverticulitis

Question 12

Where is diverticulitis pain typically found?

Answer 12

LIF

Localised peritonitis

Question 13

What are the four main blood tests to run in diverticulitis?

Answer 13

FBC
CRP/ESR
Amylase
G+S/XM

Question 14

What imaging would you request in diverticulitis? (4)

Answer 14

Erect CXR
AXR
Contrast CT
Gastrograffin enema

Question 15

What scope would you request in diverticulitis?

Answer 15

Flexi sig

Question 16

What system is used to classify bowel perforation due to diverticulitis?

Answer 16

Hinchey

1 = small confined pericolic abscess
2 = large abscess extending into pelvis
3 = generalised purulent peritonitis
4 = generalised faecal peritonitis

Question 17

What Hinchey grades require definite surgery?

Answer 17

3 and 4

Question 18

What is the outpatient Mx of an acute attack of diverticulitis? (2)

Answer 18

Fluid only diet

Augmentin +/- metronidazole

Question 19

What are indications for admission in a patient with diverticulitis? (2)

Answer 19

Cant keep fluids down

Pain cant be controlled

Question 20

What is the inpatient panagement of acute diverticulitis? (4)

Answer 20

NBM
IVI
Analgesia
Cef+Met

Question 21

What are the indications for surgery in a pt with diverticulitis? (3)

Answer 21

Perf
Large haemorrhage
Stricture -> obstruction

Question 22

What surgical procedure is required for acute severe diverticulitis?

Answer 22

Hartmann’s

Question 23

What is a hartmann’s procedure?

Answer 23

surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy

Question 24

What are the main signs of complications to watch out for in diverticulitis pts?

Answer 24

Sudden onset pain with generalised peritonitis and shock (=perf)

Sudden painless bright red PR bleed (=haemorrhage)

Swinging fever, localising signs and leukocytosis (=abscess)

Fistulae (enterocolic, colovaginal, colovesicular

Question 25

What complication can occur in the months and years following diverticulitis?

Answer 25

Fibrous strictures form