Diverticular diseases Flashcards
What is a diverticulum?
A diverticulum (plural diverticula) is a pouch or pocket in the colon wall, usually ranging in size from 0.5 – 1cm, frequently in the sigmoid colon.
Differentiate these terms:
- Diverticulosis
- Diverticular disease
- Diverticulitis
Definitions and disease process:
- Diverticulosis = presence of diverticula
- Diverticular disease = diverticula are symptomatic (5%)
- Diverticulitis = inflammation of diverticulum
What are the main causes of diverticular disease? Name 4.
- Low fibre diet -> constipation:
- Commonly eaten in developed countries
- Rare in rural Africa - Obesity
- Smoking
- NSAIDs
Name 2 risk factors for diverticular disease.
- Older patients (>50 YO)
- Low fibre diets.
How does a diverticula form?
Diverticula formation:
1. Diverticular forms at gaps in the wall of the gut, where blood vessels penetrate.
- In a low fibre diet, the colon must push harder to move things along (fibre helps gut motility) , o pressure increases.
- This pressure increase results in pouches of mucosa being extruded through the muscular wall through weakened areas near blood vessels, leading to diverticula formation.
- There is also thickening of the muscle layer.
What part of the bowel is most likely to be affected by diverticulitis?
The descending colon.
Describe the pathophysiology of diverticulitis.
Out-pouching of bowel mucosa -> faeces can get trapped here -> obstruct the neck of the diverticula -> allow bacteria to multiply -> abscess and inflammation -> bowel perforation -> rupture of vessels (bleeding) = diverticulitis.
Describe how Diverticular disease can cause intestinal obstruction.
Out-pouching of mucosa -> faeces trapped -> inflammation in bowel wall -> contraction -> obstruction.
Describe the clinical presentation of diverticular disease.
- Asymptomatic in 95% of cases and is usually detected incidentally on colonoscopy or barium enema examination
- In symptomatic cases:
- Intermittent left iliac fossa (LIF) pain
- Erratic bowel habit
- In severe cases:
4. Severe pain and constipation due to luminal narrowing
Give 4 symptoms of diverticular disease.
- Bowel habits changed
- Bloating / flatulence
- Left lower quadrant pain (intermittent LIF pain)
- Nausea & vomiting
Describe the symptoms for diverticulitis.
Symptoms of diverticular disease:
- Bowel habits changed
- Bloating / flatulence
- Left lower quadrant pain
- N&V
Diverticulitis:
All of the above
+ FEVER
+ Blood in stool
What would you observe as symptoms for diverticulitis upon examination?
- Febrile
- Tachycardia
- Abdominal examination:
* Tenderness, guarding and rigidity on the LEFT SIDE of abdomen
* A palpable tender mass is sometimes felt in the left iliac fossa
Diagnosis of diverticulitis.
- Physical examination:
- Tenderness + guarding (peritoneum irritated)
- Distended and tympanic to percussion (gas)
- Bowel sounds diminished (colon not working well) - Bloods (inflammatory!)
- Polymorphonuclear leucocytosis - increased levels of the white
blood cell polymorphonuclear leukocytes
- ESR and CRP raised - CT Colonoscopy (use for acute bleeds)
= Best for diagnosis
- Sigmoidoscopy or colonoscopy are NOT performed during acute
attack
Management of diverticular disease.
In uncomplicated symptomatic disease:
- Recommend a well-balanced HIGH FIBRE DIET with smooth muscle relaxants
I.E. antispasmodics e.g. MEBEVERINE
Management of diverticulitis.
Mild attacks can be treated with oral antibiotics e.g. CIPROFLOXACIN and METRONIDAZOLE.
- Those with signs of systemic upset (fevers, tachycardia) and significant abdominal pain require bowel rest, IV fluids and IV antibiotics.
- Surgical resection is occasionally required.
