Diverticular Diseases

Question 1

Diverticular Disease

Answer 1

Predominantly pockets in the left hand side of the colon - sigmoid colon.

Question 2

Risk factors for diverticular disease

Answer 2

low fibre diet
diet high in red meat
lack of physical activity
obesity
some medicines
connective tissue problems

Question 3

definition of diverticulosis

Answer 3

presence of diverticula, without inflammation or infection. diverticular disease is when patient’s experience symptoms

Question 4

definition of diverticulitis

Answer 4

inflammation and infection of diverticula

Question 5

pathophysiology of diverticula

Answer 5

within the circular muscle of the colon, the area where blood vessels penetrate into the wall is a weakness. there is increased pressure inside the lumen over time, can cause a gap to form in these areas of the circular muscle. These gaps allow the mucosa to herniate through the muscle layer and form pouches (diverticula).

Question 6

why do diverticula not form in the rectum?

Answer 6

it has an outer longitudinal muscle layer that completely surrounds the diameter of the rectum, adding extra support.

Question 7

which areas of the colon are more vulnerable to the development of diverticula?

Answer 7

the areas not covered by teniae coli - these are longitudinal muscles that run along the colon.

Question 8

presentation of acute diverticulitis

Answer 8

pain and tenderness in the left iliac fossa/lower left abdomen
fever
diarrhoea
nausea and vomiting
rectal bleeding
palpable abdominal mass (if an abscess has formed)
raised inflammatory markers (e.g., CRP and WCC)

Question 9

management of uncomplicated diverticulitis in primary care

Answer 9

oral co-amoxiclav (at least 5 days)
analgesia (avoiding NSAIDs and opiates, if possible)
only taking clear liquids (avoiding solid food) until symptoms improve
follow-up within 2 days to review symptoms

Question 10

hospital management of severe diverticulitis

Answer 10

NBM or clear fluids only
IV abx and fluids
analgesia
urgent investigations (e.g., CT scan)
urgent surgery may be required for complications

Question 11

complications of acute diverticulitis

Answer 11

perforation peritonitis
peridiverticular abscess
large haemorrhage requiring blood transfusions
fistula (e.g., between the colon and the bladder or vagina)
ileus/obstruction

Question 12

Bedside test to do in females for suspected diverticulitis

Answer 12

pregnancy test

Question 13

First line imaging for diverticulitis

Answer 13

CT abdomen and pelvis - should be with contrast unless contraindicated. helps to assess severity, prognosis and identify complications

• include X-ray: show free air under the diaphragm

Question 14

surgical management of diverticulitis

Answer 14

radiologically guided drainage of abscess or laparoscopic washout
Hartman’s procedure - end colonstomy with rectal stump

Question 15

Complications of diverticulitis

Answer 15

bowel obstruction
peritonitis
abscess
fistula
bleeding
strictures

Question 16

What is the modified hinchey classification?

Answer 16

used to help guide the need for surgical intervention

I A: confined pericoli inflammation/phlegmon
I B: confined pericolic abscess

II: Pelvic, retroperitoneal or distant intraabdominal abscess

III: generalised purulent peritonitis

IV: generalised faecal peritonitis