Diverticular Disease Flashcards
is an outpouching of the gut wall.
Diverticula
multiple outpouchings of the bowel wall and are asymptomatic
for patients who are symptomatic.
Diverticulosis
Diverticular Disease
when one of the diverticula become infected. When stagnant faeces cause bacterial accumulation and infection within a diverticula.
diverticulitis
where do majority +/- complications occur and why?
sigmoid colon as it is the narrowest
pathogenesis of diverticula?
therefore patients often have a longstanding Hx of?
High intraluminal pressures (often due to lack of fibre – constipation) force the mucosa to herniate through the muscle layers of gut at weak points. Pressure of hard stools passing through the large intestine that has become weakened with age causes the bulges to form.
constipation (low fibre diet)
what % of westerner’s have diverticulosis by age 60 and why?
30% - low fibre diet
difference between diverticular disease and diverticulitis in regards to:
- pain?
- infectious signs?
PAIN
DD = left sided colicky pain relieved by defecation
Diverticulitis = LIF pain w/ localised peritonism and guarding/tenderness
Infectious Signs
DD = none
Diverticulitis = fever, tachycardia, vomiting, diarrhoea, ^WCC,ESR,CRP
Dx of diverticulosis?
incidentally on colonoscopy
Dx of Diverticulitis?
CT abdo best to confirm
Diverticular Disease?
AXR/Erect CXR
then CT Abdo w/ oral and IV contrast not CT cologram to identify acute inflammation
Classification?
Hinchey classification (I TO V)
Prevention?
Laxatives and high fibre diet
Tx of Diverticular Disease
Increase dietary fibre intake
Try anti-spasmodics (Mebervine)
Surgical resection often needed
Tx of Diverticulitis
mild attacks?
more severe?
- what IV Abx in severe?
recurrent episodes?
mild
- at home with bowel rest (fluids only) and oral Abx
severe
- NBM
- IV fluids
- IV Abx (cephalosporin+metronidazole)
recurrent
- sigmoid resection
why don’t you do colonscopy in DD or diverticulitis
risk of perforation
