Diverticulitis Flashcards
Diverticula disease
Outpouching of the intestinal mucosa that is symptomatic
Diverticulosis
Asymptomatic outpoutching of the intestinal mucosa
Diverticulitis
Acute infection and inflammation of the diverticulae
Where are diverticula most commonly found
Sigmoid colon as higher pressure
Risk factors
Age - 60 - 70 yrs old Lack of dietary fibre - loss of stool bulk Obesity Sedentary lifestyle Smoking NSAID use
Presentation of diverticula disease
Intermittent LIF pain
Altered bowel habits - constipation or diarrhoea
PR bleeding
Presentation of diverticulitis
Severe LIF pain
Nausea and vomiting
Change in bowel habits - diarrhoea or constipation
PR bleeding
Signs:
- fever
- tachycardia
- tender LIF
- guarding and rigidity if peritonitis
- sometimes
Diverticular disease investigations
Abdominal examination Obs Bloods - FBC (raised WCC), CRP Urine dipstick - exclude UTI Pregnancy test
Imaging:
- barium enema
- flexible sigmoidoscopy and colonoscopy
- CT
Diverticulitis investigations
Abdominal examination Obs Bloods - FBC (raised WCC), CRP Urine dipstick - exclude UTI Pregnancy test
Imaging:
- CT
- CXR - May show pneumoperitoneum if perforated
- AXR - dilated bowel loops if obstructed
DO NOT DO BARIUM ENEMA OR FLEXIBLE SIGMOIDOSCOPY due to risk of perforation
Diverticular disease management
Conservative:
- increase dietary fibre
Mild:
- oral antibiotics - ciprofloxacin and metronidazole
Severe/ complicated:
- IV abx
- IV fluids
- analgesia
- urgent surgery
Complications of diverticular disease
Diverticulitis Perforation and peritonitis - sepsis Fistula formation Intestinal obstruction Bleeding Mucosal inflammation
When to admit to hospital
If the symptoms of diverticulitis do not settle within 72 hours or if severe symptoms
