Diverticular Disease Flashcards
What is a GI diverticulum?
Outpockets of colonic muscosa/submucosa usually at sites of perforation by arteries. NOT INFLAMED
What is diverticular disease?
Divertuclum have become symptomatic
What is diverticulitis?
Inflammation of diverticulum
What are the two main types of diveritculum?
Aquired
Congenital
What causes diverticulum?
UNKNOWN, SEVERAL THEORIES
- fibre deficiency
- change in strength of colonic wall w/ age/CT deficiencies
Describe the fibre deficiency theory
Lack of dietary fibre –> high intraluminal pressure –> mucosa herniates adjacent to perforating arteries
Describe the colonic wall theory
Change in strength of colonic wall due to
-age
-CT disorders
-collagen disorder
Weakened, increased risk of diverticulitis
What are the risk factors for diverticular disease?
>50 Low dietary fibre Obesity Smoking NSAIDs/Paracetamol Marfans, Ehler's-Danlos, PKD
Where do most diverticulum occur?
Sigmoid colon
-95% of complications here
In what less common places can diverticulum occur?
Right colon
Massive single diverticulum anywhere
What are the complications of diverticulosis?
Perforation
Abscess formation
Bleeding
Fistula formation
What are the symptoms/signs of diverticular disease?
Can be asymptomatic Left sided colic (relieved by defecation Altered bowel habit (blood/mucus) Nausea Flatulence Severe pain/constipation (if luminal narrowing)
What investigations are appropriate in suspected diverticular disease?
PR (pelvic abscess? colorectal cancer?)
Sigmoidoscopy/Colonoscopy
Barium enema
CT
What is the 1st line medical management for diverticular disease?
Mebeverine
What is diverticulosis?
The presence of diverticula
What causes diverticulitis?
Infection due to stagnation of contents of diverticula
What are the sx of diverticulitis?
Severe L. sided colic
Constipation (or overflow diarrhoea)
Sx mimicking appendicitis BUT on the left
What are the signs of diverticulitis?
Fever Tachycardia Tenderness, guarding, rigidity (on LHS) Palpable mass in LIF Raised WCC/inflam markers
What are the management options for mild attacks of diverticulitis?
UNCOMPLICATED - LOW GRADE FEVER
- bowel rest (fluids only) at home
- oral co-amoxiclav +/- metronidazole
What are the management options for severe attacks of diverticulitis?
COMPLICATED - HIGH GRADE FEVER
- admit if pain cannot be controlled/oral fluids not tolerated
- analgesia, IV fluids, NBM
- IV cefuroxime & metronidazole
- erect CXR, AXR, contrast CT
- DO NOT SCOPE
What are the potential complications of diverticulosis?
Perforation Abscess formation Bleeding Fistula formation Intestinal obstruction Strictures
What are the key features of perforation, as a complication of diverticulosis?
Usually in acute diverticulitis
Can lead to abscess formation/peritonitis/fistula
Presents w/ ileus & peritonitis +/- shock
Mortality 40%
Manage w/ laparotomy +/- Hartmann’s
What are the key features of abscess formation, as a complication of diverticulosis?
Presents w/ swinging fever, leucocytosis & localising signs
Drain under CT guidance
What are the key features of bleeding, as a complication of diverticulosis?
Sudden painless OR chronic occult
Large volumes can be lost
Often stop w/ bed rest
If do not stop treat w/ angiography + embolisation
-adrenaline injections & diathermy may negate need for surgery
