Diverticulitis, Diverticular disease, Diverticulosis

Question 1

Overview

Answer 1

KEY WORD: FIBRE

Lack of fibre will cause stool to struggle to pass through large intestine.

Diverticular are small pouches/spikes on colon. These come from slow moving stools due to lack of fibre.

Diverticular + NO symptoms = Diverticulosis

Diverticular + symptoms of pain, diarrhoea, rectal bleed, Bloating = Diverticular disease

Diverticular + SEVERE symptoms and then inflammation then infection = Diverticulitis.

VISUAL OVERVIEW ON PHONE

Question 2

Treatment overview

Answer 2

BPSA Mnemonic
Bulk laxatives (Ispaghula husk, bran, methylcellulose)
Paracetamol
Surgery
Antispasmodics (Mebeverine, Alverine, peppermint oil, hyoscine butylbromide)

Question 3

Diverticulosis (NO symptoms)

Answer 3

Asymptomatic condition

Presence of diverticula (small pouches that protrude from the colon)

Age dependent usually occur in >40. >40 at more risk

Question 4

Diverticular disease & Diverticulitis

Answer 4

Diverticular disease
- Diverticula are present
Symptoms:
- abdo tenderness,
- constipation,
- diarrhoea,
- rectal bleed,
- intermittent LOWER abdo pain

WITHOUT inflammation/infection.

Symptoms overlap with IBS/Colitis

Risk increases with age >40 more likely.

Acute diverticulitis
- Happens when diverticula suddenly become inflammed & Infected.

Symptoms:
- Constant LOWER abdo pain
- Fever
- Sig. rectal bleed
- Sudden change in bowel habits
- Abdo tenderness
- Abdo mass

Complications: Abscess, Bowel perforation, intestinal obstruction, sepsis. MUST REFER

NON Drug Treatment for both
- Diet and lifestyle changes (increase fibre)
- Weight loss
- Smoking cessation
- Exercise
- Complicated acute diverticulitis - Emergency or elective surgery may be needed.

Drug Treatment
Diverticulosis:
- NO TREATMENT as NO symptoms
- Bulk laxative for constipation

Diverticular disease:
NO antibiotics.
- Bulk laxative when high fibre unsuitable or patient has persistent constipation
- Simple analgesics (paracetamol for abdo pain)
- Antispasmodics for abdo cramps.
- NSAIDs/Opioids NOT recommended (Cause diverticular perforation)

Acute Diverticulitis
- Simple analgesics
- REFER IF complications occur.
- Consider antibiotics after a while if no improvement.
- AVOID Prophylactic antibiotics or amino salicylates.
- REFER URGENTLY IF sig rectal bleed.