Diverticular Disease Flashcards
What is a diverticulum
Outpouching of bowel wall that is composed of mucosa
Where are diverticulum commonly found
Sigmoid colon
What is diverticulitis
Inflammation of diverticulum
What is the epidemiology of diverticular disease
50% of over 50s
70% of over 80s
25% of cases become asymptomatic
Affects men more than women
What is the pathophysiology of diverticular disease
Bowel becomes weakened over time
Increase in luminal pressure by movement of stool
In weakened areas protrusion or outpouching of mucosa occurs
In the outpouching pockets of bowel contents and bacteria can accumulate
Build up of bacteria
Causes inflammation
Can perforate and result in peritonitis
What are the risk factors
Low fibre diet Obesity Smoking Family history NSAID use
How does simple diverticular disease present
Left lower abdo pain (colicky, relieved by defecation)
Altered bowel habit
Nausea
Flatulence
How does diverticulitis present
Abdo pain and localised tenderness in the left iliac fossa
If perforation has occurred - localised/generalised peritonism and rebound tenderness
PR bleeding - sudden sometimes painless
Anorexia
Nausea
Vomiting
Which drugs can cause late presentation of diverticulitis and mask symptoms
Corticosteroids and immunosuppressants
What are the findings on examination in diverticulitis
Usually unremarkable
Severe cases may reveal a mass (secondary to abscess formation)
Which fistulae can form in diverticulitis
Colovesical - between bowel and urethra
Colovaginal
What are the symptoms of colovesical and colovaginal fistulae
Colovesical - pneumoturia, faecaluria or recurrent UTIs
Colovaginal - copious vaginal discharge and recurrent infections
What are the differentials for diverticulitis
IBD bowel cancer Appendicitis Mesenteric ischaemia Gynae causes - ovarian cyst, torsion Renal stones
How would suspected diverticulitis be investigated
Bloods - FBC, U+ES, LFTs, clotting, group and save (crossmatch if severe blood loss)
If severe ABG - look at lactate for sepsis or bowel ischaemia
Urine dipstick - exclude urological causes e.g. UTI, pyelonephritis, left renal colic
Imaging
AXR - exclude obstruction
Erect CXR - if perforation suspected
CT abdo pelvis - high level of accuracy in diagnosing symptomatic diverticular disease
Flexi sig if rectosigmoidal lesion suspected
Why shouldnt flexi sigs be done in suspected diverticulitis
Increased risk of perforation
