Diverticular Disease Flashcards
What are diverticular?
Outpouching of the bowel
What is the difference between a true diverticular and a pseudo diverticular?
True- all layers of the bowel wall are heniating
Pseudodiverticula- only the submucosa and mucosa are herniating, these are more common
What is the most common form of diverticula?
Pseudodiverticula where only the submucosa and mucosa herniate
What are some risk factors for diverticulosis?
Low fibre diet
High fat and high fat diet
What are some symptoms of diverticular disease?
Diverticular disease is when symptoms develop due to diverticula
Abdominal pain- typically LLQ
Peritonitis if perforation
Bleeding- Mild or severe
What is the management for bleeding due to diverticular?
Colonoscopy to manage the bleed- thermocoagulation, adrenaline injection
Angiography can also be done to identify the source - embolisation can be done to stop the bleed
Surgery if above fail to remove the bleeding section
Note- Upper GI bleeds can be ruled out via gastric lavage or OGD
What is diverticulitis?
Infection of the diverticulum caused by faecal matter sitting in the diverticulum and damage to the mucosa of the diverticulum
What are the symptoms of diverticulitis?
LLQ abdo pain
Fever
Change in bowel habit
What are some complications of diverticular?
Bleeding- Colonoscopy, Angiography, Surgery
Diverticulitis
Perforation leading to peritonitis
Fistula formation
What can happen if a fistula forms between the colon and the bladder in diverticulitis?
Dysuria
Air in the urine
Poo in the urine/faecal matter
What investigations might you request if suspecting diverticulitis?
Bloods- FBC, U&Es, CRP, ESR, Iron (may be IDA due to bleeding)
Stool- Culture, Microscopy, C.Diff Toxin, Parasite testing
CT Scan with contrast of abdomen and pelvis
What is the main investigation for diverticular disease?
CT with contrast of abdomen and pelvis
NOTE- DO NOT SAY COLONOSCOPY BECAUSE THIS INVOLVES PUMPING LARGE VOLUMES OF AIR INTO THE COLON WHICH INCREASES THE RISK OF PERFORATION AND PERITONITIS
How can diverticulitis be managed initially?
ABx- e.g. Metronidazole Ciprofloxacin
IV Fluids
Analgesia
If abscesses drain these
If perforation urgent surgery, elective surgery to remove affected area if not
What advice should be given to reduce the risk of diverticulitis/diverticulosis?
High fibre diet
Stay hydrated
Where do most diverticular form?
Colon
What is Meckel’s Diverticulum?
A true diverticulum that is a congenital abnormalities- can cause intussusception leading to bowel ischaemia and obstruction. The bowel kind of folds on itself.
What is a complication of Meckel’s Diverticulum?
Intussusception causing bowel ischaemia and obstruction
What is the management for bowel obstruction?
NG Tube Decompression- aspirate the stomach contents
IV Fluids
Parenteral nutrition
Correct the obstruction
Where is a common site of fistula formation in diverticulitis?
Bladder to colon- colovesical fistual
UTI
Air in the urine (pneumaturia)
Faecal matter in the urine (faecaluria)
Why would you do stool cultures in a patient with suspected acute diverticulitis?
To rule out infective causes of diarrhoea
Yersinia Salmonella Shigella Campylobacter E.Coli
Check for C.Diff Toxin Too
What is the investigation for suspected diverticulitis/diverticular disease?
CT with Contrast
Not a colonoscopy as this involves pumping large amounts of air into the colon and could precipitate a perforation
What might be seen in a CT contrast for diverticulitis with a perforation?
Air within the peritoneal cavity
Out-pouching of the bowel
Fistulas- especially with the bladder can occur
Abscesses show a fluid collection
If a perforation is found on the CT what is indicated?
Immediate surgery to resect the damaged area
