Diverticular Disease

Question 1

def of diverticulosis

Answer 1

presence of diverticulae outpouchings of the colonic mucosa + submucosa thrrough the muscular wall of the large bowel

Question 2

def

Answer 2

diverticulosis + complications (haemorrhage, infection, fistulae)

Question 3

def of diverticulitis

Answer 3

acute inflammation & infection of colonic diverticulae

Question 4

what is the hinchley classification of acute diverticulitis

Answer 4

Ia phlegmon (inflammation of connective tissue)
Ib/II localised abscesses
III perforation with purulent peritonitis
IV faecal peritonitis

Question 5

aetiology

Answer 5

low fibre diet causing loss of stool bulk
therefore high colonic intraluminal pressures must be generated to propel stool
leads to herniation of mucosa +submucosa through muscularis

Question 6

pathogenesis

Answer 6

diverticulae most common in sigmoid + descending colon
consist of herniated mucosa + submucosa through the muscularis
if faecal matter enters diverticulae, can lead to bacterial overgrowth, toxin production leading to diverticulitis

Question 7

epi

Answer 7

common
>40yrs
60% with diverticulae in developed countries

Question 8

history

Answer 8

asymptomatic (85%)
pr bleeding
diverticulitis causing LIF or lower abdomen pain

Question 9

history with diverticular fistulation into bladder

Answer 9

pneumaturia (air in urine)
faecaluria (poo in urine)
recurrent UTIs

Question 10

examination

Answer 10

diverticulitis

• tender abdomen
• local/generalised peritonitis if perforation has occurred

Question 11

investigations

Answer 11

1 bloods
-FBC (increased WCC)
-increased CRP in diverticulitis
2 barium enema
-shows presence of diverticulae with a saw-tooth appearance of lumen
3 flexible sigmoidoscopy & colonscopy
-diverticulae can be seen
-exclude polyps/tumour

Question 12

what imaging investigation would be used in an acute setting for diverticular disease

Answer 12

CT scan

Question 13

management

Answer 13

1 asymptomatic
-high fibre diet (20-30g/day)
2 GI bleed
-IV hydration
-antibiotics
-transfusion if necessary
3 diverticulitis
-IV antibiotics
-IV fluids
-bowel rest
4 surgery
-for recurrent attacks or development of complications
-Hartmann's procedure

Question 14

what is hartmann’s procedure

Answer 14

open surgery

resection & stoma

Question 15

complications

Answer 15

diverticulitis
perforation
colonic obstruction
fistula formation (bladder, small intestine, vagina)
haemorrhage

Question 16

prognosis

Answer 16

10-25% of patients will have one or more episodes of diverticulitis