Diverticular / diverticulitis

Question 1

Diverticulosis

Answer 1

diverticula (small pouches protruding from walls of large intestine) present in lining of intestine
~ age dependent, with majority of patients aged 40 years and over.

Question 2

Diverticular disease

Answer 2

condition where diverticula present with symptoms ~ abdominal tenderness &/or mild, intermittent lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds

Question 3

Acute diverticulitis

Answer 3

diverticula suddenly become inflamed or infected.
Signs + symptoms = constant lower abdominal pain (usually severe) together i.e. fever, sudden change in bowel habits + significant rectal bleeding, lower abdominal tenderness, or palpable abdominal mass

Question 4

Complicated acute diverticulitis

Answer 4

refers to diverticulitis + complications i.e. abscess, bowel perforation & peritonitis, fistula, intestinal obstruction, haemorrhage, or sepsis.

Question 5

Non-drug tx of diverticulitis

Answer 5

diet + lifestyle changes

advised to eat healthy, balanced diet +whole grains, fruit & vegetables.

~ if constipation & on low fibre diet, gradual increase of dietary fibre may minimise flatulence & bloating. Patients increasing dietary fibre advised to drink adequate amount of fluid, especially if dehydration risk. Advice also given about benefits of exercise, weight loss (if overweight or obese), and Smoking cessation, in reducing risk of symptomatic disease & acute diverticulitis.

informed that it may take several weeks for benefits of increasing fibre in diet to be achieved & that if high-fibre diet tolerated, it continued for life.

Question 6

Diverticulosis tx

Answer 6

Bulk-forming laxatives if constipation

Question 7

Diverticular disease tx

Answer 7

Antibacterials NOT recommended

Bulk-forming laxatives if high-fibre diet unsuitable, or persistent constipation or diarrhoea.

use simple analgesia i.e. paracetamol if ongoing abdominal pain, & antispasmodics in those with abdominal cramps.

NSAIDs / opioid NOT recommended = as increase risk of diverticular perforation.

Question 8

Acute diverticulitis

Answer 8

1. simple analgesia (paracetamol) if systemically well. Consider watchful waiting and no antibacterial prescribing strategy, and advise patients to re-present if symptoms persist or worsen.

Refer if suspected complicated acute diverticulitis & uncontrolled abdominal pain for same-day hospital assessment. Those presenting with significant rectal bleeding referred to hospital urgently.

TX with amino-salicylates or prophylactic antibacterials NOT recommended to prevent recurrent acute diverticulitis.