Diverticulitis Flashcards
What is a diverticulum?
A pouch or pocket in the bowel wall, usually ranging in size from 0.5-1cm
What is diverticulosis?
Presence of diverticula without inflammation or infection (in an asymptomatic patient)
What is diverticular disease?
Where diverticula cause symptoms, without inflammation and infection
What is diverticulitis?
Where diverticula become inflamed and infected
What are the risk factors for diverticulitis?
Low fibre diet
Obesity
NSAIDs
Smoking
What is the presentation of acute diverticulitis?
Pain in the left iliac fossa
Fever
Diarrhoea or constipation
Nausea and vomiting
Rectal bleeding
Left iliac fossa mass (if abscess has formed)
Rigidity, guarding, rebound or percussion tenderness
What is the hinchey classification of diverticulitis?
Stage 1A - phlegmon (localised area of inflammation)
Stage 1B - pericolic or mesenteric abscess
Stage 2 - pelvic abscess
Stage 3 - purulent peritonitis
Stage 4 - faecal peritonitis
What investigations are used in the diagnosis of diverticulitis?
FBC - anaemia, leukocytosis, neutrophilia
U&Es - pre-renal AKI
CRP - elevated
VBG - raised lactate if significant bleed
Group and save
Blood cultures
What is the investigation of choice in acute diverticulitis?
CT abdo/pelvis with contrast
- Would show thickened bowel wall
What is the management of mild diverticulitis?
Analgesia - avoid NSAIDs and opiates
Oral co-amoxiclav for 5 days (cefalexin with metronidazole if penicillin allergic)
Liquid diet
What is the management of severe diverticulitis?
IV fluids and analgesia
IV antibiotics - co-amoxiclav or cefuroxime with metronidazole if penicillin allergic
Blood products may be needed if acute PR bleeding
Surgery if bleeding is not controlled or perforation present
What are the complications of diverticulitis?
Fistulae
Abscess
Perforation
Peritonitis
Strictures
Obstruction
