Diverticular Disease Flashcards
What is Diverticuli? (2)
GI diverticulum is an outpouching of the gut wall, usually at sites of entry of perforating arteries.
Diverticula can be aquired or congenital and may occur elsewhere, but the most important are acquired colonic diverticula.
What is the pathology?
Most within sigmoid colon with 95% of complications at this site, but right-sided and massive single diverticula can occur.
High intraluminal pressures (due, perhaps, to lack of dietary fibre) force the mucosa to herniate through the muscle layers of the gut at weak points adjacent to penetrating vessels. 30% of Westerners have diverticulosis by age 60. The majority are asymptomatic.
How is it diagnosed?
Colonoscopy - common incidental finding
CT abdomen - best to confirm acute diverticulitis, identify the extent of disease and any complications
AXR - identify obstruction or free air
What is diverticular disease?
Altered bowel habit ± left-sided colic relieved by defecation; nausea and flatulence. High-fibre diets do not help symptoms; try antispasmodics, eg mebeverine 135mg/8h PO. Surgical resection occasionally resorted to.
What is diverticulitis?
Inflammation of diverticulum. Features of Diverticular Disease + pyrexia, raised WCC, raised CRP/ESR, a tender colon ± localized or generalized peritonism.
What is the treatment of diverticulitis?
Mild attacks can be treated at home with bowel rest (fluids only) ± antibiotics.
If fluids and pain not tolerated, admit for analgesia, NBM, IV fluids and IV antibiotics.
Most attacks settle but complications include abscess formation (necessitating percutaneous CT-guided drainage), or perforation.
Beware diverticulitis in immunocompromised patients (eg on steroids) who often have few symptoms and may present late.
What are the complications?
Perforation, haemorrhage, fistulae, abscesses, post-infective strictures
What is diverticular disease?
Symptomatic Diverticuli
What is Diverticulitis?
Diverticulitis refers to inflammation of a diverticulum.
