Diverticular disease

Question 1

diverticulum definition

Answer 1

out-pouching of tubular structure

Question 2

true diverticulum

Answer 2

composed of complete wall (e.g. Merkel’s)

Question 3

false diverticulum

Answer 3

composed of mucosa only (pharyngeal, colonic)

Question 4

epidemiology of diverticulosis (prevalence, sex ratio)

Answer 4

30% of Westerner’s have diverticulosis by 60 years old

F>M

Question 5

pathophysiology of diverticulosis

Answer 5

Assoc. with ↑ intraluminal pressure (Low fibre diet: no osmotic effect to keep stool wet)
Mucosa herniates through muscularis propria at points
of weakness where perforating arteries enter.

Question 6

most common site for diverticulosis

Answer 6

sigmoid colon

Question 7

Saint’s triad?

Answer 7

hiatus hernia
cholelithiasis
diverticular disease
(commoner in obese pts.)

Question 8

symptoms of diverticular disease

Answer 8

Altered bowel habit ± left-sided colic (Relieved by defecation)
Nausea
Flatulence

Question 9

treatment of diverticular disease

Answer 9

high fibre diet, mebeverine may help

elective resection for chronic pain

Question 10

diverticulitis

Answer 10

Inspissated faeces → obstruction of diverticulum → inflammation
(Elderly pt. with prev Hx of constipation)

Question 11

presentation of diverticulitis

Answer 11

abdo pain & tenderness (typically LIF, localised peritonitis)
pyrexia

Question 12

blood tests for diverticulitis

Answer 12

FBC: ↑WCC
↑CRP/ESR
Amylase
G+S/x-match

Question 13

imaging for diverticulitis

Answer 13

Erect CXR: look for perforation
AXR: fluid level / air in bowel wall
Contrast CT
Gastrograffin enema

Question 14

endoscopy for diverticulitis

Answer 14

flexi sigmoidoscopy

colonoscopy (not in acute attack)

Question 15

Hinchey grading

Answer 15

1. Small confined pericolic abscesses Surgery rarely
   needed
2. Large abscess extending into pelvis (May resolve w/o
   surgery)
3. Generalised purulent peritonitis (Surgery needed)
4. Generalised faecal peritonitis (Surgery needed)

Question 16

treatment of mild attacks of diverticulitis

Answer 16

treat at home with bowel rest (fluids only) & augmentin +/- metronidazole

Question 17

medical management of diverticulitis

Answer 17

Nil by mouth
IV fluids
Analgesia
Antibiotics: cefuroxime + metronidazole
Most cases settle

Question 18

surgical management of diverticulitis (indications)

Answer 18

perforation
large haemorrhage
Stricture → obstruction

Question 19

surgical managment of diverticulitis (procedure)

Answer 19

Hartmann’s to resect diseased bowel

Question 20

complications of diverticulitis

Answer 20

perforation
haemorrhage
abscess
fistulae
strictures