Diverticular disease Flashcards
Diverticulum definition
Outpouching of gut wall, often where arteries perforate
Diverticulosis definition
Presence of diverticula, when symptomatic is known as diverticular disease
Diverticulitis definition
Inflammation of diverticula, can be acquired or congenital (rarer)
Diverticular disease pathology
High intraluminal pressure (maybe due to lack of dietary fibre) results in herniation of mucosa through muscle layers of gut
Diverticular disease diagnosis
Often incidental finding during colonoscopy
CT abdomen to confirm diverticulitis, can identify extent and complications e.g. colovesical fistula
AXR identifies complications e.g. perforation/obstruction
Diverticular disease symptoms
Altered bowel habit
Can have left-sided colic relieved by defecation
Nausea
Flatulence
Diverticular disease treatments
Anti-spasmodics e.g. mebeverine 135mg/8 hours
Surgical resection in very severe cases not helped by medication
Diverticulitis features
diverticular disease + : pyrexia inc WCC,inc CRP tender colon localised/general peritonism
Diverticulitis management
Mild attacks treated with bowel rest (just fluids) and maybe antibiotics
More severe requires IV antibiotics + fluids, analgesia and NBM
Diverticular disease complications
Perforation (ileus, peritonitis, shock) - Hartmann’s procedure
Haemorrhage - embolisation or colonic resection if ongoing bleed
Fistulae - enterocolic/colovaginal/colovesical needs resection
Abscess - ABX and drainage
Post-infective strictures
Diverticulitis surgical indications
Degree of infective complication:
stage 1 - pericolic/mesenteric abscess (no surgery)
stage 2 - walled off/pelvic abscess (may not need surgery)
stage 3 - purulent peritonitis (needs surgery)
stage 4 - faecal peritonitis (needs surgery)
Elective surgery for stenosis, fistula, recurrent bleeding
