Diverticulitis Flashcards
what is the definition of diverticulitis?
Diverticulitis indicates inflammation of a diverticulum or diverticula and may be caused by infection.
Diverticular disease may be defined as any clinical state caused by symptoms pertaining to colonic diverticula and includes a wide-ranging spectrum from asymptomatic to severe and complicated disease.
what is the epidemiology of diverticulitis?
Increases with age
Higher prevalence e in western world
Vegetarians show less incidence
Female predominance in later life
what is the aetiology of diverticulitis?
diverticular disease is thought to be of multifactorial aetiology. Both genetic and environmental factors are described as causative, especially a low dietary fibre intake, which in Western populations is deemed as the predominant contributing factor.
Other predisposing factors described include decreased physical activity, obesity, increased red meat consumption, tobacco smoking, excessive alcohol and caffeine intake, steroids, and non-steroidal anti-inflammatory drugs.
what are the risk factors for dicerticulitis?
Over 50yr
Low fibre diet
Diet rich in salt, meat and sugar, obesity, NSAIDs, opioids
what is the pathophysiology of diverticulitis?
Inspissated food particles or faecal material may contribute to the development of infection, which when combined with increased intraluminal pressure, may cause inflammation, ischaemia, and necrosis of the wall of a diverticulum, leading to perforation. Microperforation of 1 or more diverticula may result in a localised phlegmon, a small confined abscess (stage I), a distant abscess (stage II), generalised peritonitis (stage III) or free perforation, and faecal peritonitis (stage IV)
what are the key presentations of diverticulitis?
Presence of risk factors LLQ pain Leukocyturia Fever Rectal bleeding
what are the signs of diverticulitis?
Risk factors
leukocytosis
what are the symptoms of diverticulitis?
Rectal bleeding LLQ pain Fever Guarding and tenderness in LLQ Bloating Constipation Pelvic tenderness Diarrhoea, palpable mass
what are the first line investigations of diverticulitis?
FBC with differential - polymorphonuclear leukocytosis
Urea and electrolytes - uraemia, high creatinine
C-reactive protein - raised
what are the differential diagnoses for diverticulitis?
Endometriosis
Colorectal cancer
Appendicitis
how is diverticulitis managed?
Acute diverticulitis uncomplicated:
Analgesia, antispasmodic, oral antibiotic, ,low-residue diet
Acute diverticulitis with bleeding:
Stable bleeding, IV antibiotic, analgesia, low-residue diet, surgery
Acute diverticulitis with abscess, perforation, fistulae, obstruction:
Radiological drainage, IV antibiotic, analgesia, low-residue diet
how is diverticulitis monitored?
Flexible sigmoidoscopy or colonoscopy is recommended after the resolution of the first episode of acute diverticulitis to rule out colorectal cancer or other differential diagnoses
what are the complications of diverticulitis?
Fistula Colorectal neoplasm Abscess Perforation Obstruction
what is the prognosis of diverticulitis?
Most patients with uncomplicated diverticulitis recover following medical treatment and do not require surgical intervention.
