Diverticular Disease

Question 1

Diverticular disease

Diverticulum
Diverticulosis
Diverticular Disease
Diverticulitis

Definitions

Answer 1

Diverticulum - outpouching of mucosa through muscle layer due to increased intraluminal pressure.g. Constipation

Diverticulosis - presence of diverticulum

Diverticular disease - symptomatic diverticulosis

Diverticulitis - inflammation of diverticula

Question 2

Clinical Features

Diverticular disease vs diverticulitis

Answer 2

Diverticular disease: altered bowel habit, L sided colicky pain and relieved by defecation

Diverticulitis: fever, abdo pain that becomes LIF constant and tenderness, PR blood or mucus

Question 3

Diverticulitis Complications

Answer 3

Haemorrhage

Perforation - peritonitis signs

Abscess

Fistula formation (e.g. colovesical presenting with gas in urine and is diagnosed by cystoscopy, colovaginal fistulae presenting with frequent vaginal infections)

Chronic stricturing

Question 4

Investigations

Answer 4

BLOODS:
Raised inflammatory markers
Microcytic Anaemia

IMAGING:
CT
Gastrogaffin enema /swallow and AXR
Endoscopy and colonoscopy (but not in diverticulitis bc risk of perforation)

Question 5

Management

Diverticular disease vs. Diverticulitis vs. Obstruction/ perforation

Answer 5

Diverticular disease
- conservative: fibre, fluid, lose weight

DiverticuLitis

• mild: bowel rest at home only fluids
• very unwell: NBM, NGT and fluids / drip and suck, antibiotics ( ceftriaxone and metronidazole), analgesia

Obstruction or perforation
- resection: usually Hartman’s procedure because usually diverticula that perforate are in sigmoid colon as the pressure is highest there

Question 6

Risk Factors

Answer 6

Obesity

Smoking

Nonsteroidal anti-inflammatory drugs

Corticosteroids

Opiates