Diverticulitis

Question 1

What is diverticulosis

Answer 1

presence of diverticula (out-pouching) in an asymptomatic patient

Question 2

What is diverticular disease

Answer 2

diverticula cause symptoms, such as intermittent lower abdominal pain, without inflammation and infection

Question 3

What is diverticulitis

Answer 3

Inflammation of diverticulum
Causes severe lower abdominal pain, fever, general malaise, and occasionally rectal bleeding

Question 4

Epidemiology of diverticula

Answer 4

• More common with increasing age
• Sigmoid colon affected mostly
• 30% of Westerners have diverticulosis by age 60.

Question 5

RFs

Answer 5

• Increasing age
• Obesity
• Smoking
• NSAIDs
• Low dietary fibre

Question 6

What is colonic diverticulosi

Answer 6

formation of outpouchings (diverticula) in the wall of the colon, most frequently affecting the sigmoid due to its small diameter (small diameter = higher pressures).

Question 7

True and pseudodiverticula

Answer 7

True = Diverticula include all layers - mucosa to serosa
Pseudodiverticula= mucosa + submucosa

Question 8

Formations of colonic diverticula

Answer 8

High pressure pushes walls so they bubble out and form pouches

Question 9

Where do diverticula tend to form

Answer 9

spots where the blood vessels that supply the intestinal walls traverse the muscle layer

This spot is slightly weaker, making it more likely for diverticula to form.

Question 10

What happens as diverticula form?

Answer 10

blood vessel responsible for wall weakness becomes separated from the intestinal lumen by mucosa > therefore subject to injury and predisposed to rupture > result in bleeding which can pass into stool

Question 11

Pathophysiology of diverticular disease

Answer 11

High pressures in colon / weak wall ~~> diverticula ~~> if faecal matter or bacteria gather ~~> inflammation and rupture of vessels = diverticulitis

Question 12

How does diverticulitis happen?

Answer 12

• fecal matter, or fecaliths, become lodged in the diverticula (less common)
• erosion of the diverticular wall from higher luminal pressures.

Question 13

Risk factors for high pressures in colon

Answer 13

Constipation
Obesity
NSAID’s
Smoking

Question 14

Signs of Diverticular disease + diverticulitis

Answer 14

• Pyrexia
• Left lower quadrant or iliac fossa tenderness and guarding
• Left iliac fossa tender mass
• Tachycardia

Question 15

Symptoms of diverticular disease

Answer 15

• Bowel habits changed
• Bloating
• Flatulence
• Left lower quadrant pain
• N&V

Question 16

Symptoms of diverticulitis

Answer 16

Same as diverticular disease

And FEVER AND BLOOD IN STOOL

Question 17

Complications of diverticular disease

Answer 17

• Infection ~~ abscess
• Bowel perforation
• Peritonitis
• Haemorrhage
• Obstruction
• Fistulae into adjacent organs

Question 18

What would you expect to find on examination for diverticular disease

Answer 18

• Tenderness and guarding
• Distended and tympanic to percussion
• Bowel sounds diminished

Question 19

Investigations

Answer 19

FBC
U&Es
CRP and ESR
VBG

Question 20

Gold standard examination for diverticular disease

Answer 20

Contrast CT SCAN ~~~> ultrasound MRI

Question 21

Diverticulitis management

Answer 21

Mild: oral antibiotics, analgesia, low residue or liquid diet
Severe:
- NBM, IV fluids and analgesia
- IV antibiotics:co-amoxiclav is typical but depends on local guidelines
- surgery
- diverticular abcess

Question 22

Key diagnostic factors of diverticular disease

Answer 22

• Left lower quadrant abdo pain
• Leukocytosis
• Fever

Question 23

Complications of diverticular disease

Answer 23

• Fistulae
• Abcess
• Perforation
• Strictures