Diverticulitis

Question 0

S+S?

Answer 0

Painless GI bleeding
Fever
LIF pain (although can be right/suprapubic, left groin or back) 
Constipation 
Urinary urgency common

Question 1

What is diverticulitis? Risk factor?

Answer 1

Inflammation/micro-perforation of a colonic diverticulum (outpouching). Most commonly in sigmoid.

Low fibre diet.

1/2 of everyone over 60 in western countries.

Question 2

RFs for GI diverticulitis bleeding?

Answer 2

HTN
Atherosclerosis
Regular NSAID use

Question 3

Ix?

Answer 3

CBE EUC LFT CRP

RAD
CT
Colonoscopy to rule out CRC

Question 4

Staging of diverticulitis?

Answer 4

1 - small peri colic abcess
2 - large abcess/fistula
3 - purulent peritonitis (ruptured abscess)
4 - feculent peritonitis

Question 5

Rx?

Answer 5

Hinchey 1 - conservative: triples, bowel rest, Pethidine for lowering intraluminal pressure.

Advise high fibre diet

Hinchey 2 - percutaneous drainage via CT.
Elective sigmoidectomy after recovery from infection.

Hinchey 3 and 4
Laparotomy to identify and excise perforated colon. Hartmanns

Question 6

What is Hartmanns?

Answer 6

Sigmoidectomy and stoma

10 weeks later - anastomoses descending colon and rectum