Diverticular disease Flashcards
What is diverticular disease?
Outpouchings of the colonic mucosa and submucosa through inherent weakness in the outer muscle layers.
What is the commonest site for diverticular diseae?
Sigmoid colon
What are the risk factors?
- Increasing age
- Hereditary factors
- Chronic constipation
- High intake of meat and red meat
- Smoking
- NSAIDs
What are the frequent complications?
- Infection resulting in diverticulitis
- Bleeding
- Perforation and peritonitis
- Abscess formation
- Sepsis
- Stricture and fistula formation
- Obstruction
What is the presentation of perforation and peritonitis?
o Abdominal rigidity
o Guarding
o Rebound tenderness
Pneumoperitoneum on CXR
What is the presentation of stricture and fistula formation?
o Faecaluria
o Pneumaturia
o Pyuria
What is the presentation of an obstruction?
o Colicky abdominal pain o Constipation o Vomiting o Inability to pass flatus o Abdominal distention
What is diverticulosis?
Asymptomatic condition characterised by the presence of diverticula (small pouches protruding from the walls of the large intestine)
What are the clinical features of diverticular disease?
- Abdominal tenderness
- Intermittent LLQ abdominal pain that may be triggered by eating and relieved on defecation or flatus
- Constipation
- Diarrhoea
- Rectal bleeds
- Bloating
What is acute diverticulitis?
Diverticula suddenly become inflamed or infected
What are the clinical features of diverticulitis?
- Constant, severe abdominal pain stars in epigastrium before localising to LLQ - Sudden change in bowel habits - Rectal bleeding - LLQ abdominal tenderness - Palpable mass - Dysuria, urinary frequency - Fever - Tachycardia
How is diverticulosis with constipation managed?
Weight loss
Smoking cessation
- Increase fibre intake gradually
How is diverticular disease managed?
Weight loss
Smoking cessation
- Paracetamol (abdominal pain)
- Antispasmodics (abdominal cramps)
- Increase fibre intake gradually
- OR Bulk-forming laxatives
Fybogel (ispaghula husk)
Methylcellulose
Why are NSAIDs and opioids not prescribed in diverticular disease?
May increase the risk of diverticular perforation
How is acute diverticulitis managed?
Weight loss
Smoking cessation
- Paracetamol
- 5 days co-amoxiclav or metronidazole + cefalexin/trimethroprim/ciprofloxacin
