Diverticular disease

Question 1

What is a diverticulum?

Answer 1

Outpouching of the bowel wall

Question 2

Where diverticulum most likely to form in the colon?

Answer 2

Sigmoid colon

Question 3

What is Diverticulosis?

Answer 3

Presence of diverticula

Question 4

What is diverticular disease?

Answer 4

symptomatic diverticula

Question 5

What is diverticulitis?

Answer 5

inflammation of the diverticula

Question 6

What is a diverticular bleed?

Answer 6

where the diverticulum erodes into a vessel and causes a large volume painless bleed

Question 7

What causes diverticulosis?

Answer 7

Aging bowel becomes weakened over time and the movement of stool within the lumen causes an increase in luminal pressure, this causes outpouchings of the mucosa through the weaker ares of the bowel wall

Question 8

Where are the weaker areas of bowel wall?

Answer 8

Junctions of the triangular muscle sheets and blood vessels penetrate to supply the bowel wall

Question 9

What causes diverticulitis?

Answer 9

bacteria can overgrow in the outpouchings causing inflammation

Question 10

What happens if one of the outpouchings perforates in diverticulitis?

Answer 10

Peritonitis, sepsis and death could occur

Question 11

In chronic cases of diverticulosis, what can form?

Answer 11

Fistulae usually colovesical or colovaginal

Question 12

What is complicated diverticulitis?

Answer 12

abscess presence, fistula formation, stricture or free perforation

Question 13

What are the risk factors for diverticulosis?

Answer 13

Low dietary fibre intake, obesity, smoking, family history and NSAID use

Question 14

What are the clinical features of diverticulosis?

Answer 14

many are asymptomatic and are found during colonoscopy or CT imaging

Question 15

What are the features of diverticular pain?

Answer 15

intermittent lower abdominal pain, received by defecation, altered bowel habit, nausea and flatulence

Question 16

What are the features of diverticulitis?

Answer 16

acute abdominal pain that is sharp and in the left iliac fossa, worsened on movement and localised tenderness, may also have reduced appetite, pyrexia, nausea

Question 17

What are the features of a perforated diverticulum?

Answer 17

localised peritonism or generalise peritonitis, can be fatal

Question 18

What are the complications of diverticular disease?

Answer 18

Pericolic abscess, fistula formation and bowel obstruction

Question 19

What are the differential diagnosis for diverticular disease?

Answer 19

inflammatory bowel disease or bowel cancer, mesenteric ischaemia, gynaecological causes or renal stones

Question 20

What are the laboratory tests that should be done for suspected diverticulosis?

Answer 20

routine bloods such a FBC and CRP and a faecal calprotectin

Question 21

What laboratory tests should be done for suspected divericulitis?

Answer 21

routine bloods, group and save and venous blood gas, urine dipstick

Question 22

What imaging should be done for uncomplicated diverticular disease?

Answer 22

Flexible sigmoidoscopy

Question 23

What imaging should be done for suspected divertculitis?

Answer 23

CT abdomen-pelvis scan as will show thickening of the colonic wall, pericolonic fat stranding, abscesses, localised air bubbles or free air

Question 24

Why should colonoscopy not be preformed on suspected diverticulitis?

Answer 24

risk of perforation

Question 25

How can diverticulitis be staged?

Answer 25

Using the Hinchey classification

Question 26

What is the management for diverticular disease?

Answer 26

simple analgesia, oral fluid intake

Question 27

What is the conservative management for diverticulitis?

Answer 27

IV antibiotics, fluids, bowel rest, analgesia,

Question 28

How are diverticular bleeds managed?

Answer 28

embolisation or surgical resection if do not settle conservatively

Question 29

When is surgical management required with diverticulosis?

Answer 29

faecal peritonitis or overwhelming sepsis, usually hartmans procedure

Question 30

What are the complications of diverticulitis?

Answer 30

recurrence of diverticulitis