Diverticular disease Flashcards
What is a diverticulum?
Outpouching of mucosa that herniates through the muscular (intestinal) wall
Where do diverticula most commonly occur?
usually at sites between the tenia coli at presumed sites of weakness where the vasa recti penetrate the colonic wall
Most at sigmoid colon due to small diameter
What is diverticulosis?
Have diverticula, not necessarily symptomatic
What is diverticulitis?
Inflammation of diverticula, symptomatic
What is diverticular disease?
Any clinical state with diverticula from aymptomatic to complicated
What causes diverticula?
Can be acquired or congenital (Meckel’s)
Acquired = due to high intraluminal pressure + weak points
Risk factors for diverticulosis?
Low fibre diet Red meat Alcohol Caffeine Steroids and NSAIDs Lack of exercise Obesity >50 years old Abnormal colonic motility/wall structure
What is the average age of presentation with diverticulitis?
50-70
Signs/symptoms of diverticular disease
Chronic history of intermittent abdominal pain (LLQ)
Bloating
Change in bowel habit
Symptoms of diverticulitis
Severe abdominal pain (LLQ) Nausea and vomiting Change in bowel habit (usually constipation) Urinary frequency, urgency or dysuria PR bleeding
Signs of diverticulitis
Low grade pyrexia
Tachycardia
Tender LIF (may have tender palpable mass)
Possibly reduced bowel sounds
Guarding, rigidity and rebound tenderness
Complications of diverticular disease
Diverticulitis Obstruction Perforation Haemorrahge Fistulae e.g. enterocolic, colovaginal, or colovesical Abscesses Post-infective strictures
Blood tests for acute diverticulitis?
FBC U+E LFTs CRP Amylase Group and save Blood cultures
Gold standard imaging for acute diverticulitis?
Contrast CT (lower abdo)
Medical management of acute diverticulitis?
NBM
Abx
Fluids
