Diverticulosis

Question 1

What is a diverticula?

Answer 1

Pouches protruding from the colon wall
(True diverticula) affect all layers of the intestinal wall; rarely occur
(Pseudodiverticula) Not all layers of the intestinal wall protrude; the diverticulum is only covered by a layer of mucosa and submucosa, not by a muscular layer

Question 2

What is diverticulosis?

Answer 2

Diverticula without evidence of infection; may be asymptomatic or symptomatic

Question 3

What is the epidemiology of diverticulosis?

Answer 3

Common in Western countries
Left sided in Western
Right sided in Asian

Question 4

What are the causes of diverticulosis?

Answer 4

Increasing age
Genetic factors
Diet (low-fiber, rich in fat and red meat)
Obesity, low physical activity
Smoking

Question 5

What is the pathophysiology of diverticulosis?

Answer 5

Chronic constipation + increase weakness → protrusion of herniated intestinal mucosa and submucosa through gaps in the muscular layer of the intestinal wall

Question 6

What are the clinical features of diverticulosis?

Answer 6

Mostly asymptomatic
Most common cause of lower GI bleeding in adults
Abdominal pain

Question 7

How is diverticulosis diagnosed?

Answer 7

(Asymptomatic)Mostly incidental (i.e. routine colonoscopy)
(Symptomatic) Colonoscopy
Double contrast barium enema (less common)
US

Question 8

What are some differential diagnosis of diverticulosis?

Answer 8

IBS
Intestinal ischemia 
Colorectal cancer 
Appendicitis 
Ectopic pregnancy 
UTI

Question 9

What is the treatment for diverticulosis?

Answer 9

(Asymptomatic) No treatment
(Symptomatic) Fluid + oxygen support
IV proton pump inhibitor

Question 10

What are some complications of diverticula?

Answer 10

Diverticular bleeds
Abscess 
Diverticular fistula
Perforation
Ulcer
Intestinal obstruction