Diverticular Dx Flashcards
What is a diverticulum
A sac like protrusion of the colonic wall
What is diverticulosis
Diverticular disease with no symptoms
Percentage of people above 70 yo that has diverticulosis
50%
What are the different evolution of diverticulosis
Diverticulitis => inflammation
Bleeding
Perforation
Stricture
Segmental colitis
Symptomatic uncomplicated diverticular
Incidence in men and women
Equally affected
Incidence in the world
More common in developed world even though found everywhere
What are some hypothesis when it comes to lower incidence in Africa
Lower life expectancy ?
Poorer access to healthcare ?
Softer stools from high roughage ?
Risk factors
Old age
Constipation
Diet with low fibers intake
Connective tissue disorders like marfan or enhler Danilo’s syndrome
Hereditary or genetic predisposition
Extreme weight loss
Heavy meat consumption
Pathology
Not fully understood but mutltifactorial
Different factors contributing to pathogenesis of diverticular disease
Genetics
Low Fiber intak e
Low Vitamin D
Obesity
Physical inactivity
Mucosal herniation in colonic wall muscle layer
Colonic motility
Clinical presentation of diverticular disease
Mostly asymptomatic
What are some possible symptoms in diverticulitis
Constipation
Diarrhea
Fever
Chills
Nausea
Bloating
Vomiting
Cramping
Lower abdominal pain
What are some complications of diverticular disease
Abscess
Fistula
Obstruction
Peritonitis
Sepsis
What could you see on examination
Colicky pain in suprapubic area or left iliac fossa
Palpable sigmoid colon
What could you see on examination in the case of diverticulitis
Local tenderness
Guarding
Rigidity
Palpable mass
Diarrhea , rectal bleeding and fever
What are some differentials to diverticular disease
Colorectal cancer
Ischemic colitis
IBD
Infection
How do you diagnosis diverticular disease
Accidentally most of the time through colonoscopy , barium enema, ct scan and flexible sigmoidoscopy
Why cant you use colonoscopy in case. Of suspected diverticulitis
Can lead to perforation
How do you manage diverticulosis with no symptoms
No treatment necessary
Diet fiber advised
Bulk Laxatives possible
In a case of symptomatic diverticulosis , how do you manage
Based on severity :
Clear liquid diet
Oral antibiotics
Drainage if abscess
Surgery
Indication for surgery
No improvement after therapy
Persistent symptoms due to diverticulitis
Compromised immune system evaluation is good
Complicated diverticulitis history
Bleeding does not stop after some time
