Diverticular Disease/Diverticulitis

Question 1

What do the following refer to:

• diverticulum
• diverticulosis
• diverticulitis

Answer 1

• Diverticulum
  
  • Pouch in bowel wall
• Diverticulosis
  
  • Presence of divertula, without inflammation or infection, can be refered to as diverticular disease when patient experiences symptoms
• Divertiulitis
  
  • Inflammation and infection of diverticula

Question 2

AETIOLOGY

Answer 2

• Combination of genetics and environmental factors
• Environmental
  
  • Low fibre
  • Low exercise
  • Obesity
  • Red meat consumption
  • Smoking
  • Alcohol
  • Caffeine

Question 3

AETIOLOGY

Pathophysiology

Answer 3

• Large intestine wall contains layer of muscle called circular muscle
• Where this is penetrated by blood vessels are weak points
• Increased pressure in lumen can cause gap to form allowing mucosa to herniate through muscle layer and pouches to form diverticula
• Do not form in rectum because outer longitudinal muscle completely surrounds it adding suport
• In rest of colon there are 3 longitudinal muscles (teniae coli) that do not completely surround it

Question 4

CLINICAL FEATURES

Presentation

Answer 4

• Pain and tenderness in left iliac fossa/lower left abdomen
• Fever
• Diarrhoea
• Nausea and vomiting
• Rectal bleeding
• Palpable abdominal mass (if abscess formed)
• Raised inflammatory markers (eg CRP and WBC)

Question 5

INVESTIGATIONS

First choice

Answer 5

• FBC - leuckocytosis
• U&E - uraemia, elevated creatinine
• CRP - raised

Question 6

MANAGEMENT

General principles

Answer 6

• Uncomplicated managed in primary care conservatively
• Complicated or severe pain requires hospital admission

Question 7

MANAGEMENT

Uncomplicated management

Answer 7

• Oral co-amoxiclav (5 days)
• Analgesia (avoid NSAIDs and opiates if possible)
• Only drink clear liquids
• Follow up in 2 days to review

Question 8

MANAGEMENT

Complicated management

Answer 8

• Admission to hospital
• Nil by mouth
• IV antibiotics
• IV fluids
• Analgesia
• Urgent investigation by CT scan
• Urgent surgery maybe for complications

Question 9

COMPLICATIONS

Answer 9

• Perforation
• Peritonitis
• Peridiverticular abscess
• Large haemorrhage requiring blood transfusions
• Fistula (e.g., between the colon and the bladder or vagina)
• Ileus / obstruction