Diverticular Disease

Question 1

How does diverticular disease occur.

Answer 1

Acquired outpouching of bowel mucosa secondary to high intraluminal pressures.

Question 2

What part of the colon does diverticular disease most commonly affect.

Answer 2

Sigmoid and descending colon.

However, it can affect any part of the colon.

Question 3

What is a possible cause of diverticular disease.

Answer 3

It has been postulated that it is secondary to low-fibre Western diets.

Question 4

What does ‘diverticulosis’ mean.

Answer 4

It is the existence of diverticula with no inflammation.

Question 5

What does ‘diverticulitis’ mean.

Answer 5

It is inflammation of a diverticulum.

Question 6

What does ‘diverticular disease’ mean.

Answer 6

It is diverticula associated with abdominal pain and disturbed bowel habits.

Question 7

What are the symptoms of diverticular disease. (5)

Answer 7

It largely depends on the site, severity and presence of complications. 
Common symptoms include:
Abdominal pain (usually LIF).
Fever. 
Altered bowel habit. 
Nausea. 
PR bleeding.

Question 8

What are the physical signs associated with diverticular disease. (4)

Answer 8

Pyrexia.
Localised tenderness.
Guarding and rebound/percussion tenderness. (often in LIF).
Do a PR for localized tenderness/blood.

Question 9

Who does diverticular disease usually affect.

Answer 9

Usually affects those over 50.

Question 10

What is the prevalence of diverticular disease.

Answer 10

It occurs in 50% of patients over 50.

Question 11

In what percentage of patients is diverticular disease asymptomatic.

Answer 11

It is asymptomatic in 95% of patients.

Question 12

What does ‘diverticular colitis’ mean.

Answer 12

The term refers to crescenteric inflammation on the folds in areas of diverticulosis.

Question 13

When does diverticulitis occur.

Answer 13

It occurs when faeces obstruct the neck of the diverticulum, causing stagnation and allowing bacteria to multiply and produce inflammation.

Question 14

What are potential complications of diverticulitis. (5)

Answer 14

Bowel perforation (peridiverticulitis).
Abscess formation - usually pericolic. 
Fistulae into adjacent organs - usually colovesical.
Generalized peritonitis.
Acute rectal bleeding.

Question 15

How is diverticular disease diagnosed in asymptomatic patients.

Answer 15

Incidentally on a colonoscopy or barium enema examination.

Question 16

What can occur in sever diverticular disease.

Answer 16

Luminal narrowing in the sigmoid colon. This causes severe pain and constipation.

Question 17

What part of the colon is most commonly affected in acute diverticulitis.

Answer 17

It most commonly affects diverticular in the sigmoid colon.

Question 18

How does acute diverticulitis present. (6)

Answer 18

Severe pain in LIF.
Fever.
Constipation.
Tachycardia.
Abdominal tenderness, guarding and rigidity on the left side.
Sometimes a palpable tender mass is felt in the LIF.

Question 19

What term is used to describe the acute presentation of diverticulitis.

Answer 19

Left-sided appendicitis.

Question 20

What is the differential diagnosis for a patient presenting with symptoms of diverticulitis. (4)

Answer 20

Colorectal cancer.
Inflammatory bowel disease.
Infection.
Ischaemic colitis.

Question 21

Who is more likely to suffer a complication of diverticular disease.

Answer 21

Patients taking NSAIDs or aspirin.

Question 22

What is the recurrence rate for a patient who has suffered an acute attack of diverticulitis.

Answer 22

About 3% per year.