Diverticulitis / Diverticulosis / Diverticular Disease

Question 1

what is a diverticulum

Answer 1

a pouch or pocked in the bowel wall, usually ranging in size from 0.5-1cm

Question 2

what is diverticulosis

Answer 2

the presence of a diverticula without inflammation or infection. can be referred to as diverticular disease if symptoms are experienced (distension, flactulence, pelvic heaviness)

“wear and tear of bowel” most commonly affects the sigmoid colon but can affect large intestine in some patients and small bowel diverticula is possible but uncommon

Question 3

diverticulitis

Answer 3

inflammation and infection of the diverticula caused by inspissated access, producing persistent lower abdominal pain and peritonism when there is serial involvement.

Question 4

what is the pathophysiology of diverticular disease

Answer 4

the large intestine contains a layer of muscle- circular muscle. there is an area of weakness where this muscle layer is penetrated by blood vessels.

increased pressure in the lumen over time can cause a gap to form in the areas of circular muscle. the mucosa can herniate through the muscle layer and form pouches (diverticula)

*they do not occur in rectum because this has longitudinal muscle layer (extra support)

areas that are not covered by tenure coli are vulnerable to developing diverticula

Question 5

risk factors for diverticulosis

Answer 5

increased age
low fibre diet
obesity
use of NSAIDs

Question 6

diagnosis of diverticulosis

Answer 6

bedside:

bloods:

imaging:
colonoscopy
CT scan

Question 7

management of diverticulosis

Answer 7

conservative: high fibre diet, weight loss
medical: bulk forming laxatives (ispaghulxa husk), stimulants laxatives should be avoided
surgical: if significant problems

Question 8

acute diverticulitis symptoms

Answer 8

this is inflammation oft he diverticula.

pain, tenderness in LIF / lower left abdomen
fever
diarrhoea
nausea
vomiting
rectal bleeding
palpable abdominal mass
raised CRP and WBC

Question 9

management of acute diverticulitis

Answer 9

conservative:
bed rest

medical:
oral co-amoxiclav (5 days)
analgesia (avoid NSAIDs and opiates)
IV fluids and nil by mouth
only take clear liquid avoid solid food until symptoms improve
follow up and review in 2 days
IV gram negative anaeorbe sensitive antibiotics (metronidazole)

surgical
! acute abdo
! sepsis
nil by mouth
IV fluids
urgent investigations
urgent surgery
*drainage if abscess
colonoscopy or barium enema following resolution to confirm diagnosis (4-6 weeks after acute phase)

Question 10

complications of acute diverticulits

Answer 10

Perforation
Peritonitis
Peridiverticular abscess
Large haemorrhage requiring blood transfusions
Fistula (e.g., between the colon and the bladder or vagina)
Ileus / obstruction