Diverticular Disease Flashcards
What is the difference between a true and a false diverticulum?
True - outpouching of the complete wall
False - outpouching composed of mucosa only - mucosa herniates through weakness in muscularis propria where perforating arteries enter
Name a well known true diverticulum
Meckel’s
Name 2 false diverticuli
Pharyngeal
Colonic
What percentage of westerners have diverticulosis by age 60?
30%
What sex is diverticular disease most common in?
Women
Where are diverticuli most commonly located?
Sigmoid colon
What is Saint’s triad?
Describes two other diseases that are likely if the other is found:
Hiatus hernia
Gallstones
Diverticular disease
What might be lacking in the diet if diverticulum have formed?
Fibre
What are the three main symptoms of diverticular disease?
Altered bowel habit +/- left sided colic (relieved by defaecation)
Nausea
Flatulence
One conservative, medical and surgical treatment for diverticular disease?
Increase fibre intake
Mebeverine
Elective resection if chronic pain
Hard stool can block diverticuli, especially in elderly patients causing…?
Diverticulitis
Where is diverticulitis pain typically found?
LIF
Localised peritonitis
What are the four main blood tests to run in diverticulitis?
FBC
CRP/ESR
Amylase
G+S/XM
What imaging would you request in diverticulitis? (4)
Erect CXR
AXR
Contrast CT
Gastrograffin enema
What scope would you request in diverticulitis?
Flexi sig
What system is used to classify bowel perforation due to diverticulitis?
Hinchey
1 = small confined pericolic abscess 2 = large abscess extending into pelvis 3 = generalised purulent peritonitis 4 = generalised faecal peritonitis
What Hinchey grades require definite surgery?
3 and 4
What is the outpatient Mx of an acute attack of diverticulitis? (2)
Fluid only diet
Augmentin +/- metronidazole
What are indications for admission in a patient with diverticulitis? (2)
Cant keep fluids down
Pain cant be controlled
What is the inpatient panagement of acute diverticulitis? (4)
NBM
IVI
Analgesia
Cef+Met
What are the indications for surgery in a pt with diverticulitis? (3)
Perf
Large haemorrhage
Stricture -> obstruction
What surgical procedure is required for acute severe diverticulitis?
Hartmann’s
What is a hartmann’s procedure?
surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy
What are the main signs of complications to watch out for in diverticulitis pts?
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
What complication can occur in the months and years following diverticulitis?
Fibrous strictures form
