Diverticular disease Flashcards
What is diverticular disease?
Colonic diverticulosis refers to herniation of mucosa and submucosa through the muscular layer of the colonic wall and may be the result of colonic smooth muscle over-activity. (High pressure of the lumen vs wall weakness)
What are the risk factos for diverticular disease?
Low dietary fibre Age >50 years (decreased mechanical strength of colonic walls) Western diet Obesity NSAIDS
WHAT IS THE EPIDEMIOLOGY OF DIVERTICULAR DISEASE?
Most patients are asymptomatic Incidence increases with age <10% in under 40’s 50% by 50 Up to 66% in over 80’s Right sided higher in asia due to meat consumption
What are the signs and symptoms of diverticular disease?
Left lower quadrant abdominal pain/ tenderness/ guarding Rectal bleeding Constipation Bloating Diarrhoea Fever Leukocytosis Pelvic tenderness on DRE Palpable abdominal mass
What investigations may you use to diagnose Diverticular disease?
FBC AXR/ CXR CT Abdo US Abdo Contrast Enema Colonoscopy Sigmoidoscopy Angiogram Blood culture
What may investigations show?
FBC
Polymorphonuclear leukocytosis
Abdo Xray Pneumoperitoneum Ileus Soft tissue densities Free air in bowel perforation CT abdo Thickening of bowel wall Mass Abscess Streaky mesenteric fat May show gas in bladder in case of fistula US abdo Signs of abscess, perforation and obstruction CXR Normal or free air under diaphragm if perforation Contrast enema Diverticuli Abscess Perforation Obstruction Fistula Colonoscopy Single, multiple, scattered diverticula Inflammation Acute bleeds Ischaemia Neoplasm Sigmoidoscopy Mucosal pathology such as ischaemia, IBD, neoplasm Angiogram Aetiology of bleeding identified Blood culture G-ve rods Anaerobic bacteria Administration of antibiotics
What is the management plan for diverticular disease?
Fistula (Surgical repair)
Colorectal neoplasm (Cancer treatment)
Abscess (Bowel rest and broad spectrum AB/ surgery)
Perforation (Surgery)
Strictures, obstruction (Balloon dilation and stent placement)
What is the prognosis of diverticular disease?
Recurrence in 1/3 , associated with high mortality
¼ of patients remain symptomatic after surgery
