Diverticular disease Flashcards
What is a diverticulum?
Outpouching of the bowel wall
Where diverticulum most likely to form in the colon?
Sigmoid colon
What is Diverticulosis?
Presence of diverticula
What is diverticular disease?
symptomatic diverticula
What is diverticulitis?
inflammation of the diverticula
What is a diverticular bleed?
where the diverticulum erodes into a vessel and causes a large volume painless bleed
What causes diverticulosis?
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
Where are the weaker areas of bowel wall?
Junctions of the triangular muscle sheets and blood vessels penetrate to supply the bowel wall
What causes diverticulitis?
bacteria can overgrow in the outpouchings causing inflammation
What happens if one of the outpouchings perforates in diverticulitis?
Peritonitis, sepsis and death could occur
In chronic cases of diverticulosis, what can form?
Fistulae usually colovesical or colovaginal
What is complicated diverticulitis?
abscess presence, fistula formation, stricture or free perforation
What are the risk factors for diverticulosis?
Low dietary fibre intake, obesity, smoking, family history and NSAID use
What are the clinical features of diverticulosis?
many are asymptomatic and are found during colonoscopy or CT imaging
What are the features of diverticular pain?
intermittent lower abdominal pain, received by defecation, altered bowel habit, nausea and flatulence
What are the features of diverticulitis?
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
What are the features of a perforated diverticulum?
localised peritonism or generalise peritonitis, can be fatal
What are the complications of diverticular disease?
Pericolic abscess, fistula formation and bowel obstruction
What are the differential diagnosis for diverticular disease?
inflammatory bowel disease or bowel cancer, mesenteric ischaemia, gynaecological causes or renal stones
What are the laboratory tests that should be done for suspected diverticulosis?
routine bloods such a FBC and CRP and a faecal calprotectin
What laboratory tests should be done for suspected divericulitis?
routine bloods, group and save and venous blood gas, urine dipstick
What imaging should be done for uncomplicated diverticular disease?
Flexible sigmoidoscopy
What imaging should be done for suspected divertculitis?
CT abdomen-pelvis scan as will show thickening of the colonic wall, pericolonic fat stranding, abscesses, localised air bubbles or free air
Why should colonoscopy not be preformed on suspected diverticulitis?
risk of perforation
How can diverticulitis be staged?
Using the Hinchey classification
What is the management for diverticular disease?
simple analgesia, oral fluid intake
What is the conservative management for diverticulitis?
IV antibiotics, fluids, bowel rest, analgesia,
How are diverticular bleeds managed?
embolisation or surgical resection if do not settle conservatively
When is surgical management required with diverticulosis?
faecal peritonitis or overwhelming sepsis, usually hartmans procedure
What are the complications of diverticulitis?
recurrence of diverticulitis
