Diverticular disease and diverticulitis Flashcards
What is Diverticulosis?
An asymptomatic condition where diverticula is present.
What is Diverticula?
Small pouches protruding from the walls of the large intestine.
What’s the prevalence of diverticula?
It’s age dependent with the majority of patients aged 40 and over
What’s diverticular disease?
A condition where diverticula are present with symptoms.
Symptoms can overlap with colitis, IBS and malignancy
Symptoms of Diverticular disease?
Abdominal tenderness, mild intermittent lower abdominal pain with constipation, diarrhoea, or occasional rectal bleeds.
NO INFLAMMATION, NO INFECTION, NO FEVER/TEMP
What’s acute diverticulitis?
When diverticula suddenly becomes inflamed or infected.
Symptoms of acute diverticulitis?
- Constant tender lower abdominal pain
- Significant rectal bleeding
- Fever
- Sudden change in bowel habits
- Abdominal tenderness
- Abdominal mass
Inflammation and infection
What is complicated acute diverticulitis and the symptoms?
It refers to diverticulitis associated with complications such as:
- abscess
- bowel perforation,
- intestinal obstruction
- Sepsis
- Peritonitis
- Fistula
What is the aim of treatment for diverticular disease?
Improve quality of life, manage episodes of acute diverticulitis and reduce risk of recurrence and complications
What must patients be told for Diverticular disease, as part of non-drug management?
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.
Non-drug management for diverticular disease?
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
What may be the treatment for complicated acute diverticulitis?
Emergency or elective surgical management
Treatment for diverticulosis?
Because its an asymptomatic condition, there’s no specific treatment.
So just bulk forming laxatives for patients with constipation
Examples of bulk forming laxative?
- Fybogel (ispaghula husk)
- Methylcellulose
Examples of Osmotic laxatives?
- Lactulose (also called by the brand names Duphalac and Lactugal)
- Macrogol - Movicol, Laxido, CosmoCol, Molaxole and Molative
- Polyethylene glycol
Examples of stimulant laxatives?
- Bisacodyl (also called by the brand name Dulcolax)
- Senna
- Sodium picosulfate
Example of Poo-softener laxative?
- Arachis oil
- Docusate
How do bulk forming laxatives work?
Bulk-forming laxatives work by increasing the “bulk” or weight of poo, which in turn stimulates your bowel.
How do Osmotic laxatives work?
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.
How do stimulant laxatives work?
These stimulate the muscles that line your gut, helping them to move poo along to your back passage.
They take 6-12 hours
How do poo-softener laxatives work?
This type of laxative works by letting water into poo to soften it and make it easier to pass.
What medications can patients with diverticular disease not use?
- Antibacterials
- Non-steroidal anti-inflammatory drugs
- Opioid analgesics
Treatment for diverticular disease?
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.
If any of the drug treatment doesn’t work and symptoms persist, what should be considered?
An alternative treatment
Drug treatment for acute diverticulitis?
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.
What should not be given for patients with recurrent acute diverticulitis?
Aminosalicylates or prophylactic antibacterials
Summary of treatments for diverticula, diverticulosis, and diverticular disease?
- Bulk laxatives
- Paracetamol
- Surgery
- Antispasmodics
