(!) Diverticular disease

Question 1

Define diverticular disease

Answer 1

diverticular disease refers to a herniation of the mucosa and submucosa of the colonic wall
Diverticulitis indicated an inflammation of the diverticula-can be caused by inflammation
Pseudo diverticula is when only the muscularis mucosa and mucosa are involved-colonic diverticula are those

can perforate

saints triad-Gallstones, diverticula and hiatus hernia

Question 2

Aetiology and risk factors diverticular disease

Answer 2

Low fibre diets result in lower transit time and reduced stool volume which increases intraluminar pressure and colonic segmentation-> risk of diverticula
also though to correlate with smooth muscle hypertrophy
Perforations results from low NO, ischemia, inflam and necrosis

saints triad-Gallstones, diverticula and hiatus hernia

Risk factors
Age
Low fibre diets
Smoking
EDS
Red meat
Alcohol, coffee
Not vegetarian
Obesity
Western diet

Question 3

Epidiemology of diverticular disease

Answer 3

Most patients don’t have Sx so hard to tell

Might be between 19-49% of older adults (up to 80% of over 80’s)

Question 4

Signs and Sx of diverticular disease

Answer 4

Asymtomatic-most common-NONE

Symptomatic uncomplicated
Mild LLQ pain
Abdo bloating
Constipation with episodes of diarrhoea

Sx diverticulitis uncomplicated-all Sx of acute diverticulitis w/o rectal bleeding
or acute abdomen (LLQ pain/guard/tender)

Symptomatic complicated
Main complication-acute diverticulitis
severe Pain LLQ, guarding, tenderness
Fever
Leukocytosis (if Hx of diverticula-diverticulitis)

Rectal bleeding-large quantities of fresh blood. painless and sudden (from abscesses)

Perforation->peritonitis=diffuse abdo tenderness

DRE-tender pelvis

Question 5

Investigations of diverticular disease

Answer 5

DRE-blood and tender pelvis indicate acute diverticular disease

FBC-Leukocytosis-if Hx of diverticula and Leuko +-> immediate suspicion of diverticulitis

Abdo Xray-shows perforation with air in abdomen
CT-thickening of wall, abscesses
Contrast enema-confirm diagnosis
if unclear-colonoscopy

Question 6

Management of diverticular disease

Answer 6

Uncomplicated-dietary modifications (more fibre and water), elective surgery (esp if recurrent diverticulitis episodes)

Symptomatic diverticulitis (no bleed)-Low residue diet and oral Abx
If Sx of acute abdomen, can manage at home after CT rules out complications
elective surgery if recurrent)

Acute divericulitis
Blood loss might be causing shock-> fluids
Colonoscopy for accurate diagnosis
1st line-IV Abx and fluids
2nd line-surgery
if not responding to ABx-still bleeding, abscess>3cm-radio drainage

Question 7

Complications of diverticular disease

Answer 7

Sx diverticular disease
Sx diverticulitis (uncomplicated)
Acute diverticulitis-lose tons of blood-shock (or peritonitis-> septic shock)

Fistula-ruptures into adjacent organ (bladder)=> faecal uria

colorectal cancer

abscesses-even random abscesses can be caused by it w/o LLQ sx
Perforation-peritonitis
Stricture-from fibrosis

Question 8

Prognosis of diverticular disease

Answer 8

mostly totally fine
Diverticular disease lowers QOL
Diverticulitis (uncomplicated) often is home treatable
and most cases fit there

Complicated tho-need fast diagnosis and respond to abx

Reccurent-1/3 recur within 5 years-worse prognosis on recurrent, worse if 1st one was bad
post surgery. 1/4 still have Sx