Diverticular Disease

Question 1

What is diverticular disease?

Answer 1

Outpouchings of colonic mucosa through the wall. They are not true diverticula like Meckel’s as doesn’t involve outpouching of all layers of colonic wall.

Question 2

Why is diverticular disease more common in the Western world?

Answer 2

Lack of dietary fibre - colon has to work harder to move contents along - higher pressures build up in the colon - mucosa pops out through tinea coli (gaps between muscle coverage).

Question 3

What is diverticulitis?

Answer 3

Acute flare up of the disease where diverticula become inflamed.

Question 4

How does diverticulitis present?

Answer 4

Abdo pain often in LIF.
Nausea.
Fever.
Diarrhoea.

Question 5

What will investigations show for a diagnosis of diverticular disease?

Answer 5

Acute episodes will show raised WCC and CRP.

Double contrast barium enema and colonoscopy can be used to identify presence of diverticula.

Question 6

What are the possible complications of diverticular disease?

Answer 6

Fistulae (bladder and small intestine).
Perforation and peritonitis.
Large bowel obstruction (strictures).
Lower GI bleed. 
Abscesses (swinging fevers).

Question 7

How is diverticular disease managed?

Answer 7

Conservative: High fibre diet, avoid small seeds and nuts (can get trapped in diverticular and irritate).
Medical: Diverticulitis can be treated with a course of abx (amoxicillin or metronidazole), long term laxatives can help keep stools soft and reduce chance of faeces trapping in diverticula. Analgesia. Fluids.
Surgical: Resection is indicated in acute inflammation unresponsive to medical management, paracolic abscess that won’t drain by radiologically guided drainage, free perforation.