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Y4: Colorectal surgery > Diverticular disease > Flashcards

Diverticular disease Flashcards

1
Q

What is a diverticulum?

A
  • Outpouching of the bowel wall
  • Commonly in the sigmoid colon
  • More common in men in devloped countries
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2
Q

What are the manifestations of diverticular disease?

A
  • Diverticulosis - presence of diverticula
  • Diverticular disease - symptomatic diverticula
  • Diverticulitis - inflammation of the diverticula
  • Diverticular bleed - the diverticulum erodes into a vessel and causes painless bleed
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3
Q

Describe the pathophysiology of diveriticular disease?

A
  • Ageing bowel becomes weakened over time
  • Movement of stool causes increased luminal pressure
  • Outpouching of mucosa occurs in areas of weaker bowel wall
  • Bacteria overgrowth at outpoutching causes diverticulitis (can perforate)
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4
Q

Describe the classification of divertiulitis?

A
  • Simple
  • Complicated
    • Abscess presence, fistual formation, stricutre, perforation
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5
Q

Risk factors for diverticular disease?

A
  • Low dietary fibre intake
  • Obesity (younger patients)
  • Smoking
  • Family history
  • NSAID use
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6
Q

What are the clinical features of diverticular disease?

A
  • Mostly asymptomatic found incidentally on colonscopy/CT
  • Diverticular pain
    • Intermittent lower abdominal pain
    • Colicky in nature, relieved by defaecation
    • Associated nausea and flatulence
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7
Q

How will diverticulitis present?

A
  • Acute abdominal pain
    • Sharp in nature
    • Normally localised in left iliac fossa pain
    • Worsened by movement
  • Features of systemic upset
    • Decreased appetite
    • Pyrexia
    • Nausea
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8
Q

How will a perforated diverticulum present?

A
  • Signs of localised peritonism or generalised peritonitis
  • Patients are frequently unwell
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9
Q

What can mask the symptoms of diverticulitis?

A
  • Corticosteroids
  • Immunosuppressants
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10
Q

Complications of divertiular disease?

A
  • Pericolic abscess
    • antibiotics and bowel rest -> CT guided drainage
  • Fistula formation
  • Bowel obstruction
    • secondary to stricture formation
    • managed through stenting or bowel resection
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11
Q

What are the common fistula subtypes?

A
  • Colovesical fistula
    • Pneumoturia (gas in urine), faecal matter in urine, recurrent UTIs
  • Colovaginal fistula
    • Copious vaginal discharge, recurrent vaginal infections
  • **Both require surgical resection and repair
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12
Q

Differentials for diverticular disease?

A
  • Inflammatory bowel disease
  • Bowel cancer
  • Mesenteric ischaemia, gynaecological causes, renal stones
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13
Q

What investigations should be performed in someone with suspected diverticular disease?

A
  • FBC, CRP, faecal calprotectin
  • Group and save, venous blood gas, urine dipstick
  • Imaging:
    • CT abdomen pelvis
    • ***Colonscopy should not be performed in causes of suspected diverticulitis due to increased risk of perforation
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14
Q

What signs on CT suggest a diagnosis of diverticulitis?

A
  • Thickening of the colon wall
  • Pericolonic fat stranding
  • Abscesses
  • Localised air bubbles
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15
Q

Describe the staging of Acute diverticulitis?

A
  • Hinchley Classification
    • Based on CT findings
    • Aids clinical management
    • Higher stages associated with higher morbidity/mortality
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16
Q

Describe the management of diverticular disease?

A
  • Mild: analgesia and encourage oral fluid intake
  • Some patients may require hospital admission for conservative or surgical management
17
Q

What may warrant hospital admission in someone with diverticular disease?

A
  • Uncontrolled pain
  • Dehydration concerns
  • Co-morbidities or immunocompromised
  • Significant PR bleeding
18
Q

Describe the convervative management of diverticular disease?

A
  • Suspected diverticulitis
    • IV antibiotics, fluids, bowel rest, analgesia
  • Diverticular bleeds
    • Usually self limiting
    • Significant bleeding with require fluids, blood products and stabilisation
19
Q

Describe the surgical management of diveriticular disease?

A
  • Requried in those with:
    • Perforation with faecal peritonitis
    • Overwhelming sepsis
  • Hartmann’s procedure
20
Q

What are the complications of diverticulitis?

A
  • Recurrence
  • Elective segmental resection in those with recurrent disease
21
Q
  • A patient is admitted with extensive PR bleeding secondary to diverticulitis. Which of the following definitive management options would not be suitable?
    1. Discuss with interventional radiology regarding consideration for potential embolectomy
    2. Hartmann’s procedure
    3. Discharge home with analgesics and oral antibiotics
    4. IV antibiotics and tranfusing blood products
A

Discharge home with analgesics and oral antibiotics

22
Q

What is a laparotomy?

A

Surgery which involves making a large incision in the abdominal wall to gain access to the abdominal cavity

23
Q

How can the septic complications of diverticular disease be classified?

A
  • Hinchley grading
    • Grade I: Localised paracolic abscess
    • Grade II: Distant abscess
    • Grade III: Purulent peritonitis
    • Grade IV: Faecal peritonitis
24
Q

What are the main differentials for a lower GI bleed?

A
  • Colorectal cancer / adenoma
  • Angiodysplasia
  • Haemorrhoids
  • Diverticulitis
  • Inflammatory bowel disease
25
Q

What medications should be avoided in diveriticular disease due to their association with a greater risk of complications?

A

NSAIDs

26
Q

Management of uncomplicated diverticular disease?

A
  • High fibre diet
  • Supplement methylcellulose
    • Bulk forming laxative
27
Q

Why is the rectum never affected by diverticular disease?

A
  • Differences in feeding vessels
  • Outer longitudinal muscle layer encompasses the full circumferance
28
Q

Why can be detected before diverticular develop?

A
  • Muscular hypertrophy
    • Seen radiologically
29
Q

What is the most common site for diverticulae development?

A
  • Sigmoid colon
    • High intraluminal pressure related to low fibre
30
Q
A

Y4: Colorectal surgery (8 decks)

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