Diverticulosis & Diverticulitis Flashcards
What is diverticulosis?
The presence of diverticula in the wall of the large intestine
What are diverticula?
A small outpouching in the wall of the large intestine
What is diverticulitis?
Inflammation of the diverticula
How do diverticula form?
They can be acquired or congenital
Acquired diverticula are caused by weaknesses in the muscle in the wall of the colon, the mucosa and submucosa bulge out through the areas of weakness
Caused by age + lack of dietary fibre
What causes colon muscle weakness?
Age, problems with nervous system
How does lack of dietary fibre cause diverticulosis?
Lack of fibre = higher intraluminal pressures
Higher pressure means the mucosal layer will be forced to herniate through at points of muscle weakness
Formation of diverticula
Which bit of the colon is more affected by diverticulosis?
Sigmoid mostly
What are the clinical features of diverticulosis?
Asymptomatic 95% of the time
Intermittent abdominal pain, usually on left side
But sometimes you can get mild or severe complications-
How would you treat the symptoms that can sometimes be caused by diverticulosis?
Dietary modification: fibre rich diet
Ant-spasmodics to help with pain
Surgical resection of segment with diverticulosis is rarely done
How is diverticulosis usually diagnosed?
Usually an incidental finding on a colonoscopy or barium enema
What are the mild complications of diverticulosis?
- altered bowel habit
- colic
- nausea
- flatulence
What are the severe complications of diverticulosis?
Bleeding which can be:
- fast, presenting with rectal bleeding
- or slow, presenting with anaemia
Differential diagnosis of diverticulosis?
Colorectal cancer IBD Colonic polyps Coeliac Many more!
What are the risk factors for developing diverticula?
Age Constipation Low fibre diet Genetic predisposition Connective tissue disorders
What causes diverticulitis?
When one or more diverticula become inflamed
Most often this is due to some faeces getting trapped in the diverticulum
The bacteria in the stool are able to multiply and cause an infection
This leads to inflammation of the affected diverticulum
What are the clinical features of diverticulitis?
Constant abdominal pain in left iliac fossa Fever Nausea Malaise Diarrhoea or constipation
Investigations of diverticulitis?
Blood:
- raised white cell count
- raised CRP + ESR
- faecal calprotectin
- CEA, carcinoembryonic antigen (bowel Ca)
Abdominal exam: tenderness of left iliac fossa
Colonoscopy
Treatment of diverticulitis?
Antibiotics!
Analgesia
IV fluids
Drainage if there’s an abscess
Surgery is indicated rarely
What are some complications of diverticulitis?
Perforation of bowel
Haemorrhage
Fistula
Abscesses
Structures
What are the clinical features of perforation of bowel?
Peritonitis (can be fatal)
Shock
Abdominal pain
What are the clinical features of haemorrhage due to diverticulitis?
Sudden and painless usually
Massive rectal bleed, or slower bleed causing anaemia
Requires transfusion
Rescusitation
