Diverticulitis Flashcards
What is diverticula formation ass with?
Low fibre diet
Lowers stool bulk, slows transit time and increases luminal pressure
Diverticulosis vs diverticular disease vs diverticulitis
Diverticulosis = asymptomatic
Diverticular disease = intermittent lower abdo pain without inflammation and infection
Diverticulitis = Diverticula inflamed from infection
Potential features of complicated diverticulitis
Ass with abscesses, peritonitis, fistual, obstruction, perforation
Risk factors diverticular disease
Older - over 50-60
Genetic
Low fibre diet
Red meat consumption
Smoking Obesity
NSAIDs + opioids
Immunosupression
Prev surgical prodcedures or colon evaluations
Comorbidities
Why might people with diverticular need an emergency trasnfusion?
Diverticular haemorrhage can occur - penetrating blood vessels responsible for bowel wall weakness vulnerable to injury
1/3 are meassive and require resus
Bleeding resolves spontaneously in majority of cases
Life threatening complications of diverticulitis
Intra abdominal abscess formation - pericolic, pelvic abscess
Perforation + peritonitis
Stricutre and fistual formation
Intestinal obstruction - fibrosis and stricture from inflammation
Sepsis
Signs of stricutre and fistula formation
Faecaluria, pneumaturia, pyuria, faeces through vagina - fistulas bladder, vagina, uterus, skin, other part of bowel
Signs of intestinal obstruciton
Colicky abdo pain
Absolute constipation - no flatus or stool
Vomitting
Abdo distension
Signs of diverticular disease
Intermittent abdo pain LLQ, tender OE
Bloat, constipation, diarrhoea, nausea
Rectal bleeding
Fever
Dysuria
When suspect diverticulitis
Constant abdo pain, severe start in hypogastrium -> LLQ
Fever
Sudden change in bowel habit + significant recta, bleeding or mucus
Tenderness in LLQ, palpable mass, history of diverticular disease
When is pain releived and triggered in diverticular disease?
Triggered by eating, relieved by passing stool or flatus
Other exams to consider apart from GI
Pelvic - gynae cause
PR exam = pelvic tenderness
Investigations diverticulitis imaging
Endoscopy
Colonoscopy
CT colonography
INvestigations general diverticulitis
FBC
Faecal occult blood test
U+Es
eGFR
Urinalysis
CRP
Important GI differential diagnosis
COLORECTAL CNACER
Bowel obstruction
Ischaemic colitis
Appendicitis
IBD
Gastroenteritis
IBS