Diverticulitis

Question 1

What is asymptomatic diverticular disease called?

Answer 1

Diverticulosis

Question 1

A disease which includes having pouches protruding outwards from the large intestine wall, and there is small mucosal herniations protruding through the intestinal layers and smooth muscle is what disease?

Answer 1

Diverticular Disease

Question 2

What is symptomatic diverticular disease called?

Answer 2

Diverticular disease

Question 3

What is the condition where there is one or more inflamed or infected diverticular?

Answer 3

Diverticulitis

Question 4

Diverticular disease is very common, and especially in industrialised countries, this can be due to a lack of what?

Answer 4

Fibre

Question 5

15-25% of patients with diverticulitis have complications which mean they need to have surgery, what are these possible complications?

Answer 5

Abscess formation, Intestinal rupture, Fistulas, Peritonitis, Bleeding

Question 6

What can cause Diverticulitis?

Answer 6

*Increased intraluminal pressure and weakening of the muscle wall of the intestine
*Abnormal colonic motility such as from opioids or IBS
*Defective muscular structure
*Changes in collagen structure such as aging

Question 7

Western people are most likely to get diverticular in what part?

Answer 7

Left-sided diverticular (Sigmoid colon)

Question 8

Asian people are most likely to get diverticular in what side?

Answer 8

Right side

Question 9

How does diverticulitis form?

Answer 9

1) Faecal material or undigestived food collects in the diverticula and causes obstruction
2) Mucus secretion and normal bacterial overgrowth leads to distension of the diverticula
3) This results in vascular compromise and perforations
4) This increases the intraluminal pressure and stuck food particles may also damage the diverticula wall which results in inflammation and necrosis and perforation
5) Recurrent attacks lead to scar tissue formation and lumen narrowing

Question 10

How is asymptomatic diverticulosis managed?

Answer 10

*High fibre diet
*Adequate fluid intake
*Weight loss
*If constipation, offer bulk forming laxatives

Question 11

What disease has intermittent pain in the lower left quadrant, and can include constipation/diarrhoea/rectal bleeding, pain is worsened by eating and relieved by passing stool or wind?

Answer 11

Diverticular Disease

Question 12

How is diverticular disease managed?

Answer 12

-High fibre diet (30g OD)
-Bran supplements / Bulk-forming laxatives
-Lifestyle advice (Fluid/weight)
-Anti-spasmodics if having cramping/gas

Question 13

What should someone with diverticular avoid?

Answer 13

*NSAIDs
*Anti-motility drugs to slow transit time (Codeine) and (Loperamide)

Question 14

If a patient has pain which is CONSTANT in the lower left abdominal pain
AND
*Fever, sudden bowel change, blood/mucus in stools, tenderness, malaise, N&V, increased WBC, increased platelets, increased CRP?

Answer 14

Diverticulitis

Question 15

How is diverticulitis managed?

Answer 15

*Refer for hospital assessment if patient is greater than 65
*Immunosuppressed /other comorbidities
*Can’t have oral Abx - need IV
*Dehydrated / at risk
*Uncontrolled abso pain + signs of complicated diverticulitis

Question 16

If a patient comes in with the following:
*Blood in stools
*Reduced GI motility
*Constipation
*Cramping
*Stomach distension
What could this indicate?

Answer 16

Complicated Acute Diverticulitis

Question 17

If a patient is acutely and systemically unwell but doesn’t need to go into hospital for there diverticulitis, what should they be given?

Answer 17

1st - Co-amoxiclav 500/125 TDS for 5 days
if PEN allergic - Cefalexin
+ Metronidazole 400mg TDS for 5 days

or Trimethoprim 200mg BD for 5 days + Metronidazole 400mg TDS for 5 days

Question 18

If someone with Diverticulitis is acute (pain) but systemically well what should we give them?

Answer 18

-No antibiotics
-Analgesia *Paracetamol (Avoid NSAID/Opioids)
-Advice on to re-present if symptoms worsen