Diverticulitis

Question 1

What is diverticulitis?

Answer 1

medical term presence of diverticula-small bulges that stick out of the side of the large intestine

Question 2

What are the possible complications of diverticulitis?

Answer 2

abcess
intestinal rupture
fistulas
peritonitis
bleeding

Question 3

What side of the colon does diverticula usually present on?

Answer 3

• Left side of the sigmoidal colon in the west
• Right side of the sigmoidal colon in asians

Question 4

what are the causes of diverticulitis?

Answer 4

• increased intraluminal pressure and weakening of muscle wall e.g due to low fibre intake
• abnormal colonic motility e.g due to ibs or opioid use
• diet- low fibre and constipation
• obesity

Question 5

Symptoms of diverticular disease

Answer 5

• flatulence
• pain worsened on eating- relieved by defecation
• lower left quadrant pain
• constipation and diarrhoea

Question 6

Management of diverticular disease

Answer 6

increase fibre to greater than 30g per day
Bulk forming laxatives
lifestyle advice- weight loss, diet, exercise, increase fluids, smoking cessation
- Anti-spasmodics e.g. mebeverine, alverine

Question 7

Symptoms of diverticulitis

Answer 7

constant lower left abdominal pain
fever
sudden bowel chage
blood or mucus in the stool
palpable abdominal mass
malaise
nausea and vomitting

Question 8

What are the treatment options for diverticulitis?

Answer 8

• Acute diverticulitis and systemically unwell (e.g. fever, tachycardia, n + v) but not needing hospital admission:
  Co-amoxiclav 500/125 TDS for 5 days
  (if allergic to penicillin = cefalexin)
  AND
  Metronidazole 400mg TDS for 5 days
  OR
  Trimethoprim 200mg BD for 5 days AND metronidazole 400mg TDS

If need hospital admission:
IV antibiotics

if acute but systemically well:
Consider no antibiotics
give analgesia e.g. paracetamol (avoid NSAIDs and opioids)