Diverticulitis Flashcards
Diverticular disease
Asymptomatic diverticulosis
Symptomatic diverticulosis
Uncomplicated diverticulitis
Complicated diverticulitis
Definition
Herniation of mucosa and submucosa through muscular layer of colon
Complications
Diverticulitis Segmental colitis Lower GI bleeding Infection Abscess Perforation Peritonitis Fistula
Most common location
Sigmoid colon
Pathophysiology
Low fibre diet= +transit time, decreased stool volume, +intraluminal pressure and colonic segmentation
Between taenia coli where the vasa recti penetrate the colonic wall
Fecal particles may lead to infection->+intraluminal pressure->inflammation, ischemia, necrosis->perforation
Primary prevention
Increasing dietary fibre intake by generous consumption of fruits and vegetable, limiting red meat and salt consumption, and undertaking regular physical activity to maintain ideal body weight and avoid obesity may help prevent diverticular disease.
Risk factors
Low dietary fibre Age >50 years Western diet Obesity NSAID
Clinical presentation
May be asymptomatic LLQ pain, guarding, tenderness Leukocytosis Fever Rectal bleeding->uncomonlly Bloating Constipation Pelvic tenderness on PR
Investigations
FBC->leukocytosis
CXR->normal
CT->thickening of bowel wall, mass, abscess, streaky mesenteric fat
May consider:
USS->abscess, phlegom, AXR->perforation, colonoscopy/sigmoidoscopy
Initial management
- Mild w/o markers of systemic involvement (no fever, N WCC):
Can be treated at home
Bowel rest (fluids only)
Analgesia - Moderate/severe
If cannot take oral fluids/pain not controlled, systemic involvement evidence->Admit
NBM, low residue diet after
IV fluids
IV antibiotics->gentamicin + amoxycillin + metronidazole
Analgesia
Consider CT percutaneous drainage if abscess formation
Erect CXR/CT contrast
Consider for surgery
If no localising signs->swinging fevers, leukocytosis
Pus somewhere, pus nowhere, pus under the diaphragm
Infective complication stages and indications for surgery
Stage 1->small, confined pericolic->rarely need surgery
Stage 2->Larger abscess->may resolve without surgery
Stage 3->Generalised suppurative peritonitis->surgery
Stage 4->fecal peritonitis->surgery
Acute rectal bleeding management
ABC, resuscitation History and examination Bloods->FBC, UEC, LFTs, Clotting, Group and hold, amylase Imaging->AXR, ECXR 2 large IV cannulae, urinary catheter Antibiotics PPI Keep bedbound Start a stool chart Keep on clear fluids Surgical consult, may require embolisation Admit if required
Typical causes of rectal bleeding
Diverticulitis CRC Hemorrhoids Crohns, UC Perianal disease Angiodysplasia Trauma, ischemic colitic, radiation proctitis
How common is diverticulitis in diverticulosis
20%
