Diverticular Disease And Diverticulitis Flashcards
__________________ is an asymptomatic condition characterised by the presence of diverticula (small pouches protruding from the walls of the large intestine)
Diverticulosis
Diverticula are defined as…?
Small pouches protruding from the walls of the large intestine
The prevalence of diverticulosis is difficult to determine but it is age dependent, with the majority of patients aged _______ years and over.
40
______________ is a condition where diverticula are present with symptoms such as abdominal tenderness and/or mild, intermittent lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds.
Diverticular disease
Symptoms of diverticular disease may overlap with other conditions such as Irritable bowel syndrome, colitis (bowel inflammation related to Crohn’s disease, Ulcerative colitis, ischaemia or microscopic colitis), and malignancy.
________________ occurs when diverticula suddenly become inflamed or infected.
Acute diverticulitis
Acute diverticulitis occurs when diverticula suddenly become ____________ or ____________.
inflamed
infected
What are the signs and symptoms of acute diverticulitis? (6)
- Constant lower abdominal pain (usually severe)
- Fever
- Sudden change in bowel habits
- Significant rectal bleeding
- Lower abdominal tenderness
- Palpable abdominal mass
What are the symptoms of diverticular disease? (4)
- Abdominal tenderness
- Mild, intermittent lower abdominal pain
- Constipation or diarrhea
- Occasional large rectal bleeds
Symptoms of diverticular disease may overlap with other conditions such as _______________, _______________, and ______________
Irritable bowel syndrome
colitis (bowel inflammation related to Crohn’s disease, Ulcerative colitis, ischemia, or microscopic colitis)
malignancy
Complicated acute diverticulitis refers to diverticulitis associated with complications such as _____________, _____________ and ___________, ___________, ______________, ____________, or ___________.
abscess
bowel perforation
peritonitis
fistula
intestinal obstruction
haemorrhage
sepsis
___________________ refers to diverticulitis associated with complications such as abscess, bowel perforation and peritonitis, fistula, intestinal obstruction, haemorrhage, or sepsis.
Complicated acute diverticulitis
What are the aims of treatment of patients with diverticular disease? (4)
Relieve symptoms
Improve QoL
Manage acute episodes of diverticulitis
Reduce risk of recurrence and complications
What lifestyle advice should be given to patients with diverticular disease? (4)
- Advise to eat a healthy, balanced diet including whole grains, fruits, and vegetables
- In patients with constipation and on a low fiber diet, a gradual increase in dietary fiber may minimize flatulence and bloating
- Patients increasing dietary fiber should be advised to drink lots of fluids, especially if dehydration is a risk
- Advise about the benefits of exercise, weight loss if overweight or obese, and smoking cessation in reducing the risk of symptomatic disease and acute diverticulitis
Patients with diverticular disease should also be informed that it may take _______________ for the benefits of increasing fibre in their diet to be achieved and that if a high-fibre diet is tolerated, it should be continued for life
several weeks
Patients with diverticular disease should also be informed that it may take several weeks for the benefits of increasing fibre in their diet to be achieved and that if a high-fibre diet is tolerated, it should be continued for __________
life
In patients with complicated acute diverticulitis, _________________ management may be required
emergency or elective surgical
What is the drug treatment of diverticulosis?
As diverticulosis is an asymptomatic condition, specific treatments are NOT recommended.
Bulk-forming laxatives can be considered for patients with constipation
As diverticulosis is an asymptomatic condition, specific treatments are not recommended. __________________ can be considered for patients with constipation
Bulk-forming laxatives
________________ are not recommended for patients with diverticular disease
Antibacterials
When should bulk-forming laxatives be considered for patients with diverticular disease? (2)
When a high-fiber diet is unsuitable
OR
for patients with persistent constipation or diarrhea
Consider the use of ______________ in patients with ongoing abdominal pain, and _____________ in those with abdominal cramps caused by diverticular disease
simple analgesia such as paracetamol
antispasmodics
What is the role of NSAIDs and opioid analgesics in the management of diverticular disease?
NOT recommended
Non-steroidal anti-inflammatory drugs and opioid analgesics are not recommended as their use may increase the risk of diverticular perforation
Non-steroidal anti-inflammatory drugs and opioid analgesics are not recommended as their use may increase the risk of _______________
diverticular perforation
For patients with persistent symptoms of diverticular disease or symptoms that do not respond to treatment, what approach should be taken?
Consider an alternative diagnosis
What is the management of patients with acute diverticulitis who are systemically WELL? (3)
- Offer simple analgesia such as paracetamol
- Consider watchful waiting and a no-antibacterial prescribing strategy
- Advise patient to re-present if symptoms persist or worsen
* Patients with persistent or worsening symptoms should be reassessed in primary care and considered for referral to hospital for further assessment
What is the management of patients with acute diverticulitis who have uncontrolled abdominal pain or suspected complications?
Same-day hospital assessment
What is the treatment of patients with acute diverticulitis who present with significant rectal bleeding?
Should be referred to hospital urgently
*Treatment with aminosalicylates or prophylactic antibacterials are not recommended to prevent recurrent acute diverticulitis
What is the role of aminosalicylates and prophylactic antibacterials in the prevention of recurrent acute diverticulitis?
Their use is NOT recommended
