Diverticular Disease Flashcards
What is a diverticulum
An out pouching of the bowel wall most commonly found in the sigmoid colon
What is diverticulosis
The presence of diverticula
What is diverticular disease
Symptomatic diverticula
what is diverticulitis
Inflammation of the diverticula
What is a Diverticular bleed
When a diverticulum erodes into a blood vessel causing large volumes of painless bleeding
what is the pathophysiology of diverticulosis
In a aging bowel, the mucosal wall become weakened over time and when the stool moves through this bowel, there is a increase in luminal pressure causing a outpouching of the weakened bowel wall.
How does diverticulitis occur
Bacteria can overgrow within the outpouchings, leading to inflammation of the diverticulum (diverticulitis) which can sometimes perforate, potentially leading to diffuse peritonitis sepsis and death.
What types of fistula can occur in chronic cases of diverticulitis
Fistula formation most commonly
Colovesical or colocovaginal
What two categories are diverticulitis divided into
Complicated and uncomplicated
what is complicated diverticulitis
Complicated diverticulitis refers to abscess presence, fistula formation, stricture, or free perforation
what is uncomplicated diverticulitis
diverticulitis describes inflammation only
what are the risk factors for diverticulitis
low dietary fibre intake, obesity (in younger patients), smoking, family history, and NSAID use.
How do patients present with diverticulosis
Aysmptomatic - most are incidentally picked up
What re the features of diverticular pain
Intermittent lower abdo pain may be colicky in nature
Altered bowel habit
Nausea
Flatulence
how does diverticulitis present
Acute abdo pain sharp in nature and normally localised to LIF
Worsened by movement
Local tenderness
Systemic upset
how does a perforated diverticulum present
signs of localised peritonism or generalised peritonitis.
what are the complications of diverticular disease
Pericolic abscess
Fistula formation
Bowel obstruction
How can we treat pericolic abscesses?
CT guided drainage
Laparoscopic wash out
Abx
How can we manage bowel obstruction secondary to diverticulitis
Stenting/bowel resection
what are the lab tests you would order to investigate diverticular disease
FBC
CRP
Faecal calprotectin
Urine dipstick
Suspected diverticulitis:
Group and save
VBG
What imaging modalities would you use to investigate diverticular disease in someone you think has uncomplicated disease
Flexible sigmoidoscopy
A colonoscopy should never be performed in any presenting cases of suspected diverticulitis, due to the increased risk of perforation
What imaging investigation would you use for someone with suspected diverticulitis
CT abdo/pelvis
What is the Hinchey classification
A classification system used to stage the disease based on CT findings
Outline the Hinchey classification
Stage 1 - pericolic/mesenteric abscess
Stage 2 - pelvic abscess
Stage 3 - purple to peritonitis
Stage 4 - faecal peritonitis
How would you manage uncomplicated diverticular disease
Simple analgesia
Encourage fluid intake
what is the conservative management of a patient with suspected/confirmed diverticulitis
IV Abx
IV Fluids
Bowel rest
Analgesia
( some can be managed as outpatients )
how can you treat diverticular bleeds
Embolisation / surgical resection
If there is significant bleeding they will need fluid resus
Sx will improve within a couple of days
But repeat imaging is required.
When is surgical intervention indicated
Only required in those with faecal peritonitis/ overwhelming sepsis
what is the surgical procedure that is performed
Hartmanns procedure
what are the complications of surgery
- recurrence of diverticulitis
