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Gastro-intestinal System > Diverticular disease and diverticulitis > Flashcards

Diverticular disease and diverticulitis Flashcards

1
Q

What is Diverticulosis?

A

An asymptomatic condition where diverticula is present.

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1
Q

What is Diverticula?

A

Small pouches protruding from the walls of the large intestine.

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2
Q

What’s the prevalence of diverticula?

A

It’s age dependent with the majority of patients aged 40 and over

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3
Q

What’s diverticular disease?

A

A condition where diverticula are present with symptoms.
Symptoms can overlap with colitis, IBS and malignancy

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4
Q

Symptoms of Diverticular disease?

A

Abdominal tenderness, mild intermittent lower abdominal pain with constipation, diarrhoea, or occasional rectal bleeds.

NO INFLAMMATION, NO INFECTION, NO FEVER/TEMP

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5
Q

What’s acute diverticulitis?

A

When diverticula suddenly becomes inflamed or infected.

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6
Q

Symptoms of acute diverticulitis?

A
  • Constant tender lower abdominal pain
  • Significant rectal bleeding
  • Fever
  • Sudden change in bowel habits
  • Abdominal tenderness
  • Abdominal mass

Inflammation and infection

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7
Q

What is complicated acute diverticulitis and the symptoms?

A

It refers to diverticulitis associated with complications such as:
- abscess
- bowel perforation,
- intestinal obstruction
- Sepsis
- Peritonitis
- Fistula

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8
Q

What is the aim of treatment for diverticular disease?

A

Improve quality of life, manage episodes of acute diverticulitis and reduce risk of recurrence and complications

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9
Q

What must patients be told as part of non-drug management?

A

Patients must be told of: diet and lifestyle changes, the course of the disease, likelihood of progression, symptoms and symptom management, investigation and treatment options.

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10
Q

Non-drug management for diverticular disease?

A

MORE FIBRE!
Patient increasing dietary fibre should drink an adequate amount of fluid, especially with risk of dehydration.

Diet n lifestyle changes.
Weight loss
Smoking cessation
Exercise

Patients should be told, it can take weeks for the benefits of increasing fibre to be achieved; but if tolerated, should be continued for life

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11
Q

What may be the treatment for complicated acute diverticulitis?

A

Emergency or elective surgical management

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12
Q

Treatment for diverticulosis?

A

Because its an asymptomatic condition, there’s no specific treatment.

So just bulk forming laxatives for patients with constipation

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13
Q

Examples of bulk forming laxative?

A
  • Fybogel (ispaghula husk)
  • Methylcellulose
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14
Q

Examples of Osmotic laxatives?

A
  • Lactulose (also called by the brand names Duphalac and Lactugal)
  • Macrogol - Movicol, Laxido, CosmoCol, Molaxole and Molative
  • Polyethylene glycol
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15
Q

Examples of stimulant laxatives?

A
  • Bisacodyl (also called by the brand name Dulcolax)
  • Senna
  • Sodium picosulfate
16
Q

Example of Poo-softener laxative?

A
  • Arachis oil
  • Docusate
17
Q

How do bulk forming laxatives work?

A

Bulk-forming laxatives work by increasing the “bulk” or weight of poo, which in turn stimulates your bowel.

18
Q

How do Osmotic laxatives work?

A

Osmotic laxatives draw water from the rest of the body into your bowel to soften poo and make it easier to pass.

They take 2-3 days to work.

19
Q

How do stimulant laxatives work?

A

These stimulate the muscles that line your gut, helping them to move poo along to your back passage.

They take 6-12 hours

20
Q

How do poo-softener laxatives work?

A

This type of laxative works by letting water into poo to soften it and make it easier to pass.

21
Q

What medications can patients with diverticular disease not use?

A
  • Antibacterials
  • Non-steroidal anti-inflammatory drugs
  • Opioid analgesics
22
Q

Treatment for diverticular disease?

A

If a high-fibre diet is unsuitable, or there is persistent constipation or diarrhoea, then use bulk-forming laxative.

  • Simple analgesia such as paracetamol can be used for ongoing abdominal pain.
    NOT NSAIDS & OPIOIDS as can cause diverticular perforation.
  • Antispasmodics can be used for abdominal cramps

Antibacterial NOT recommended.

23
Q

If any of the drug treatment doesn’t work and symptoms persist, what should be considered?

A

An alternative treatment

24
Q

Drug treatment for acute diverticulitis?

A

Simple analgesia such as paracetamol - to patients who are systemically well.

But just watch and wait and don’t prescribe antibacterial. Advise patient to come back if symptoms persist or worsen.

25
Q

What should not be given for patients with recurrent acute diverticulitis?

A

Aminosalicylates or prophylactic antibacterials

26
Q

Summary of treatments for diverticula, diverticulosis, and diverticular disease?

A
  • Bulk laxatives
  • Paracetamol
  • Surgery
  • Antispasmodics
27
Q
A

Gastro-intestinal System (6 decks)

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