Diverticular Disease and Diverticulitis

Question 1

What is Dicerticulosis?

Answer 1

Small pouches along the wall of the large intestine and is asymptomatic

Question 2

Which age group is Diverticulosis more prevalent in?

Answer 2

> 40s

Question 3

What is Diverticular disease?

Answer 3

Small pouches present in intestinal tract and is symptomatic

Question 4

Symptoms of Diverticular disease?

Answer 4

Intermittent abdominal tenderness/pain, constipation, diarrhoea, occasional rectal bleed

Question 5

What is Diverticulitis?

Answer 5

When the pouches become inflamed or infected

Question 6

Symptoms of Diverticulitis?

Answer 6

Constant severe abdominal pain, fever, sudden change in bowel habits, significant rectal bleeding

Question 7

Symptoms of complicated acute diverticulitis

Answer 7

Abscess, perforation, fistula, obstruction, sepsis, haemorrhage

Question 8

Non-drug management

Answer 8

Diet: whole grains, fruit and vegetables
Weight loss
Exercise
Smoking cessation

Question 9

Drug treatment

Answer 9

High-fibre diet
Bulk-forming laxatives when high fibre is unsuitable
Paracetamol if needed

Advise to drink adequate amount of fluid when increasing fibre

Question 10

Drugs to avoid and why?

Answer 10

NSAIDs and opioids as they may increase the risk of diverticular perforation

Question 11

Treatment of uncomplicated acute diverticulitis

Answer 11

1st: Co-amoxiclav

2nd: Cefalexin with Metronidazole OR Trimethoprim with Metronidazole OR Ciprofloxacin with Metronidazole

Question 12

Treatment of complicated acute diverticulitis

Answer 12

1st: IV Co-amoxiclav OR Cefuroxime with Metronidazole OR Amoxicillin with Gentamicin and Metronidazole

2nd: Ciprofloxacin with Metronidazole