Diverticular Disease

Question 1

What are diverticular?

Answer 1

Outpouching of the bowel

Question 2

What is the difference between a true diverticular and a pseudo diverticular?

Answer 2

True- all layers of the bowel wall are heniating

Pseudodiverticula- only the submucosa and mucosa are herniating, these are more common

Question 3

What is the most common form of diverticula?

Answer 3

Pseudodiverticula where only the submucosa and mucosa herniate

Question 4

What are some risk factors for diverticulosis?

Answer 4

Low fibre diet

High fat and high fat diet

Question 5

What are some symptoms of diverticular disease?

Answer 5

Diverticular disease is when symptoms develop due to diverticula

Abdominal pain- typically LLQ
Peritonitis if perforation
Bleeding- Mild or severe

Question 6

What is the management for bleeding due to diverticular?

Answer 6

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

Question 7

What is diverticulitis?

Answer 7

Infection of the diverticulum caused by faecal matter sitting in the diverticulum and damage to the mucosa of the diverticulum

Question 8

What are the symptoms of diverticulitis?

Answer 8

LLQ abdo pain
Fever
Change in bowel habit

Question 9

What are some complications of diverticular?

Answer 9

Bleeding- Colonoscopy, Angiography, Surgery
Diverticulitis
Perforation leading to peritonitis
Fistula formation

Question 10

What can happen if a fistula forms between the colon and the bladder in diverticulitis?

Answer 10

Dysuria
Air in the urine
Poo in the urine/faecal matter

Question 11

What investigations might you request if suspecting diverticulitis?

Answer 11

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

Question 12

What is the main investigation for diverticular disease?

Answer 12

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

Question 13

How can diverticulitis be managed initially?

Answer 13

ABx- e.g. Metronidazole Ciprofloxacin
IV Fluids
Analgesia

If abscesses drain these

If perforation urgent surgery, elective surgery to remove affected area if not

Question 14

What advice should be given to reduce the risk of diverticulitis/diverticulosis?

Answer 14

High fibre diet

Stay hydrated

Question 15

Where do most diverticular form?

Answer 15

Colon

Question 16

What is Meckel’s Diverticulum?

Answer 16

A true diverticulum that is a congenital abnormalities- can cause intussusception leading to bowel ischaemia and obstruction. The bowel kind of folds on itself.

Question 17

What is a complication of Meckel’s Diverticulum?

Answer 17

Intussusception causing bowel ischaemia and obstruction

Question 18

What is the management for bowel obstruction?

Answer 18

NG Tube Decompression- aspirate the stomach contents
IV Fluids
Parenteral nutrition
Correct the obstruction

Question 19

Where is a common site of fistula formation in diverticulitis?

Answer 19

Bladder to colon- colovesical fistual

UTI
Air in the urine (pneumaturia)
Faecal matter in the urine (faecaluria)

Question 20

Why would you do stool cultures in a patient with suspected acute diverticulitis?

Answer 20

To rule out infective causes of diarrhoea

Yersinia
Salmonella
Shigella
Campylobacter
E.Coli

Check for C.Diff Toxin Too

Question 21

What is the investigation for suspected diverticulitis/diverticular disease?

Answer 21

CT with Contrast

Not a colonoscopy as this involves pumping large amounts of air into the colon and could precipitate a perforation

Question 22

What might be seen in a CT contrast for diverticulitis with a perforation?

Answer 22

Air within the peritoneal cavity

Out-pouching of the bowel
Fistulas- especially with the bladder can occur
Abscesses show a fluid collection

Question 23

If a perforation is found on the CT what is indicated?

Answer 23

Immediate surgery to resect the damaged area