diverticulosis

Question 1

what is diverticula?

Answer 1

they are acquired and most common in sigmoid and descending colon of middle aged people

they are protrusions of mucosa covered by peritoneum

hypertrophy of circular muscle coat

inflammation result from impactation of diverticula with faecoliths which may resolve or progress to cause haemorrhage

repeated attacks of inflammation lead to thickening of bowel wall, narrowing of lumen and eventual obstruction

Question 2

what are the three types of diverticulosis?

Answer 2

asymptomatic diverticula present in over 50% of people

symptomatic diverticular disease in 10-25% cases

complicated diverticulosis (acute diverticulitis, bleeding, perforation) uncommon

Question 3

what is the pathophysiology of diverticulosis?

Answer 3

life-long refined diet with relative deficiency of fibre

condition rare in population with high fibre intake

small volume stools require high intracolonic pressures for propulsion and tis leads to herniation of mucosa between the naeniae coli

Question 4

what are the clinical features of diverticulosis?

Answer 4

result of associated constipation or spasm

colicky pain suprapubic or left iliac fossa

sigmoid colon may be palatable and attacks of diverticulitis, local tenderness, guarding, rigidity (left sided appendicitis) , palpable mass

Question 5

what are the differential diagnosis of diverticulosis?

Answer 5

colorectal cancer, ischaemic colitis, inflammatory bowel disease, infection

Question 6

what are the complications?

Answer 6

perforation

pericolic abscess

fistula formation

acute rectal bleeding

common in patients who take NSAIDS or aspirin