Diverticular Disease Flashcards
what is diverticular disease
out-pouching of the bowel epithelial lining through the muscle coat
how is diverticular disease often discovered
an incidental finding on colonoscpy
causes
high intraluminal pressure - low fibre high fat diet
common sites to occur
sigmoid colon and perforating arteries
diverticulitis means
inflamed diverticulum/diverticula.
a true diverticular includes which layers of the bowel wall
all
a false diverticular includes which layers of the bowel wall
serosa and mucosal
how are they classified
modified hinchey
modified hinchey - stage 0
clinically mild diverticulitis
modified hinchey - stage 1a
confined pericolic inflammation and phlegmonous inflammation
modified hinchey stage 1b
abscess formation <5cm near the primary inflammatory process
modified hinchey stage 2
intra abdominal abscess, pelvic or retroperitoneal abscess, distant from inflammatory process
modified hinchey stage 3
generalised purulent peritonitis
modified hinchey stage 4
faceal peritonitis
symptoms of diverticular disease
majority asymptomatic - 95%
LIF pain
altered bowel habit
flatulence
diverticulitis symptoms
as diverticular disease
fever - inc WCC
generalised peritonism
sudden onset LIF pain
rebound tenderness
sepsis
complications
- Fistulae - between colon and bladder, can cause discharge
- Perforation - can lead to abscess or peritonitis
- Obstruction
- Haemorrhage
- Stricture
investigations
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.
treatment
percutaneous drainage, fluids and antibiotics
diverticular disese if incidental finding - patient just encouraged to inc dietary fibre
treat complex diverticulitis
Hartmann’s procedure
what would you see on sigmoidoscopy/colonoscopy
colonic wall thickening, diverticula and often pericolic collections and abscesses.
what is the first line investigation
CT
