diverticular disease

Question 1

what is Diverticulosis?

Answer 1

the presence of diverticulae outpouchings of the colonic mucosa and submucosa through the muscular wall of the large bowel

Question 2

what is diverticular disease?

Answer 2

diverticulosis associated with symptomatic complications e.g. haemorrhage, infection, fistulae

Question 3

what is Diverticulitis?

Answer 3

acute inflammation and infection of colonic diverticulae

Question 4

what is the aetiology of diverticulitis?

Answer 4

o Loss of stool bulk leads to the generation of high colonic intraluminal pressures to propel the stool out
o This, in turn, leads to the herniation of the mucosa and submucosa through the muscularis

Question 5

where are diverticulae most commonly found?

Answer 5

1. sigmoid

2. descending colon

Question 6

what are the risk factors for diverticular disease?

Answer 6

o	Age 
o	Lack of fibre 
o	Obesity 
o	Sedentary life-style 
o	Smoking 
o	NSAID use

Question 7

epidemiology of diverticular disease?

Answer 7

• Diverticular disease is VERY COMMON

- right sided more common in asians

Question 8

what are the presenting symptoms of diverticular disease?

Answer 8

• Severe left iliac fossa pain and tenderness
• Anorexia, nausea and vomiting
• Diarrhoea and constipation
• Features of infection (pyrexia, raised WBC and CRP)
• PR bleeding

Question 9

signs of diverticular disease on physical examination?

Answer 9

• Tender LIF (may be a palpable mass)
• Signs of local or generalised peritonitis if a diverticulum has perforated
• Pyrexia
• Tachycardia
• Guarding, rigidity rebound tenderness

Question 10

what are the general investigations for diverticular disease?

Answer 10

• Bloods:
o FBC: increased WCC, increased CRP
o Check clotting and cross-match if bleeding

Question 11

what are the non acute investigations for diverticular disease?

Answer 11

o CT
o CT cologram
o Barium enema
o Can be difficult to exclude cancer.

Question 12

what are the acute investigations for diverticular disease?

Answer 12

o Plain abdominal films and erect chest X-Ray for checking perforation
o Abdominal CT scan with oral and IV contrast can identify abscesses

Question 13

how to classify diverticular disease?

Answer 13

Hinchey classification

I II III IV

Question 14

managing asymptomatic diverticular disease?

Answer 14

o Soluble high-fibre diet (20-30 g/day)

Question 15

managing mild diverticular disease?

Answer 15

o Antibiotics
o Liquid diet
o Hydration
o Can be treated at home for 72 hours, if persisting admit to hospital

Question 16

managing severe diverticular disease?

Answer 16

o Peri colonic abscesses should be drained either surgically or radiologically
o Recurrent episodes of acute diverticulosis requiring hospitalisation are an indication for a segmental resection
o Hinchey IV perforations require resection and usually a stoma
o Less severe perforations can be managed by laparoscopic washout and drain insertion

Question 17

Identify the possible complications of diverticular disease

Answer 17

• Diverticulitis
• Pericolic abscess
• Perforation
• Faecal peritonitis
• Colonic obstruction
• Fistula formation (bladder, small intestine, vagina)
• Haemorrhage

Question 18

prognosis of patients with diverticular disease

Answer 18

• 10-25% have one or more episodes of diverticulitis