Diverticular disease

Question 1

What is diverticular disease

Answer 1

Symptoms caused by colonic diverticula.

Diverticulosis = herniation of mucosa+submucosa through muscular layer of colon

Diverticulitis = inflammation of a diverticulum, can be caused by infection

Question 2

What are risk factors for diverticular disease

Answer 2

Low fibre
Age > 50
obesity
red meat
smoking, alcohol
men

Question 3

What are Sx of diverticular disease?

Answer 3

LLQ pain, tenderness, guarding
Bloating
Constipation
Fever
PR bleeding

Question 4

What Ix in diverticular disease?

Answer 4

Bloods: raised WBC

CT: imaging of choice. Thickening of bowel wall, mass, abscess

AXR/CXR can show pneumoperitoneum if perforation is suspected

Colonscopy if diagnosis unclear

Question 5

What is Rx of diverticular disease

Answer 5

None if asymptomatic

Dietary modification and fibre if symptoms

If diverticulitis, analgesia, Abx (met, amox, cipro), low residue diet e.g. white bread, cereal.

Patients may need blood transfusion and colonoscopy to achieve endoscopic haemostasis if severe bleeding.

Radiological drainage can be done

Question 6

Which patients will need surgery

Answer 6

Unresponsive to IV Abx
Abscess > 3 cm
Perforation
Fistulae 
Obstruction 

Colectomy can be done for patients with recurrent disease

Question 7

What are complications of diverticular disease?

Answer 7

Fistulae: when abscess ruptures into adjacent organs e.g. urinary bladder

Colorectal neoplasm

Abscess: give bowel rest and Abx

Strictures

Obstruction