Diverticular Disease

Question 1

what is diverticular disease

Answer 1

out-pouching of the bowel epithelial lining through the muscle coat

Question 2

how is diverticular disease often discovered

Answer 2

an incidental finding on colonoscpy

Question 3

causes

Answer 3

high intraluminal pressure - low fibre high fat diet

Question 4

common sites to occur

Answer 4

sigmoid colon and perforating arteries

Question 5

diverticulitis means

Answer 5

inflamed diverticulum/diverticula.

Question 6

a true diverticular includes which layers of the bowel wall

Answer 6

all

Question 7

a false diverticular includes which layers of the bowel wall

Answer 7

serosa and mucosal

Question 8

how are they classified

Answer 8

modified hinchey

Question 9

modified hinchey - stage 0

Answer 9

clinically mild diverticulitis

Question 10

modified hinchey - stage 1a

Answer 10

confined pericolic inflammation and phlegmonous inflammation

Question 11

modified hinchey stage 1b

Answer 11

abscess formation <5cm near the primary inflammatory process

Question 12

modified hinchey stage 2

Answer 12

intra abdominal abscess, pelvic or retroperitoneal abscess, distant from inflammatory process

Question 13

modified hinchey stage 3

Answer 13

generalised purulent peritonitis

Question 14

modified hinchey stage 4

Answer 14

faceal peritonitis

Question 15

symptoms of diverticular disease

Answer 15

majority asymptomatic - 95%

LIF pain

altered bowel habit

flatulence

Question 16

diverticulitis symptoms

Answer 16

as diverticular disease

fever - inc WCC

generalised peritonism

sudden onset LIF pain

rebound tenderness

sepsis

Question 17

complications

Answer 17

• Fistulae - between colon and bladder, can cause discharge
• Perforation - can lead to abscess or peritonitis
• Obstruction
• Haemorrhage
• Stricture

Question 18

investigations

Answer 18

1 - CT scan – confirm acute diverticulitis and identify extent of disease and any complications.

Gastrografin enema (X-ray of the large intestine)

Barium enema – clarify diagnosis in patients with abdominal pain and altered bowel habit.

Sigmoidoscopy/colonoscopy – risk perforation in the acute setting.

Question 19

treatment

Answer 19

percutaneous drainage, fluids and antibiotics

diverticular disese if incidental finding - patient just encouraged to inc dietary fibre

Question 20

treat complex diverticulitis

Answer 20

Hartmann’s procedure

Question 21

what would you see on sigmoidoscopy/colonoscopy

Answer 21

colonic wall thickening, diverticula and often pericolic collections and abscesses.

Question 22

what is the first line investigation

Answer 22

CT