Diverticular disease Flashcards
What causes colonic diverticular?
Low fibre diet
Fatty foods and red meat
Marfan syndrome and Ehlers danlos
What causes diverticulitis?
Ledged fecalith
Erosion (from high pressures)
Not associated with rectal bleeding (diverticulosis)
Fistula (cosovesicular (bladder))
What is diverticular disease?
Consists of herniation of colonic mucosa through the muscular wall of the colon. The usual site is between the taenia coli where vessels pierce the muscle to supply the mucosa
Altered bowel habit, bleeding, abdo pain
What are the complications of diverticular disease?
Diverticulitis Haemorrhage Development of fistula Perforation and faecal peritonitis Perforation and development of abscess Development of diverticular phlegmon
What is the severity scale- Hinchey for diverticular disease?-
I. Para-colonic abscess
II Pelvic abscess
III Purulent peritonitis
IV Faecal peritonitis
Why does diverticular disease cause a colovesicle fistula?
Recurrent attacks of diverticulitis may cause the development of local abscesses which may erode into the bladder resulting in urinary sepsis and pneumaturia
Meckel’s diverticulum aetiology
Caused by a remnant of the embryological vitellointestinal duct
Occurs in 2% of the population, 2% produce symptoms
2cm long, antimesenteric border of the bowel, 60cm from ileocaceal valve
Lined by gastric acid secreting epithelium, or heterotropic pancreatic tissue
Meckel’s diverticulum presentation
Asymptomatic/mimic other conditions…
Caecal volvulus: if tethered to umbilicus, present like volvulus with obstruction
Intussuseption: gangrenous by operation
Appendicitis: diverticulum becomes inflammed, presenting as appendicitis + umbilical cellulitis
Peptic ulceration: pain around umbilicus related to mealtimes due to ulceration of gastric acid secreting epithelium
Sinus tract: between diverticulum and umbilicus (patent vitellointestinal duct)
Aetiology of diverticulosis
50% >50y
Frequently in sigmoid (95%)
Associated with a low fibre diet (soft stools = higher luminal pressure to move them), Marfan’s, Ehlers-Danlos syndrome, PKD
Hypertrophy of the muscular propria, diverticula occuring at sites of potential weakness in the bowel wall (entry points of blood vessels)
Diverticulosis: the presence of diverticula
Diverticitis: inflammation of diverticula
Diverticular disease: symptomatic diverticula
Clinical features of diverticular disease
Asymptomatic: 95% cases
Symptoms mimic carcinoma of the colon…
Left-sided colic, relieved by defecation
Altered bowel habit: blood and mucus passage
Nausea, flatulence, severe pain, constipation
Diverticular disease investigations
PR: pelvic abscess/colorectal cancer
Sigmoidoscopy/colonoscopy
Barium enema
CT
Diverticulitis symptoms & signs
Severe left-sided colic
Constipation/overflow diarrhoea
Symptoms mimicking appendicitis but on left
Fever & tachycardia
Left-sided tenderness, rigidity and guarding
Sometimes left palpable mass in LIF
Raised WCC and inflammatory markers
Diverticular perforation pathophysiology & presentation
Acute diverticulitis –> formation of paracolic/pelvic abscess, fistula, generalised peritonitis
Presents: ileus & peritonitis +/- shock
Mortality = 40%
Abscess formation from diverticulae presentation
Swinging fever, leucocytosis, localising signs (e.g. boggy rectal mass)
Bleeding from diverticulae presentation
Sudden painless bleeding
Chronic occult loss
Large volumes can be lost, requiring transfusion
Bleeding often stops with bed rest
