Diverticulosis & Diverticulitis

Question 1

What is diverticulosis?

Answer 1

The presence of diverticula in the wall of the large intestine

Question 2

What are diverticula?

Answer 2

A small outpouching in the wall of the large intestine

Question 3

What is diverticulitis?

Answer 3

Inflammation of the diverticula

Question 4

How do diverticula form?

Answer 4

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

Question 5

What causes colon muscle weakness?

Answer 5

Age, problems with nervous system

Question 6

How does lack of dietary fibre cause diverticulosis?

Answer 6

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

Question 7

Which bit of the colon is more affected by diverticulosis?

Answer 7

Sigmoid mostly

Question 8

What are the clinical features of diverticulosis?

Answer 8

Asymptomatic 95% of the time

Intermittent abdominal pain, usually on left side

But sometimes you can get mild or severe complications-

Question 9

How would you treat the symptoms that can sometimes be caused by diverticulosis?

Answer 9

Dietary modification: fibre rich diet

Ant-spasmodics to help with pain

Surgical resection of segment with diverticulosis is rarely done

Question 10

How is diverticulosis usually diagnosed?

Answer 10

Usually an incidental finding on a colonoscopy or barium enema

Question 11

What are the mild complications of diverticulosis?

Answer 11

• altered bowel habit
• colic
• nausea
• flatulence

Question 12

What are the severe complications of diverticulosis?

Answer 12

Bleeding which can be:

• fast, presenting with rectal bleeding
• or slow, presenting with anaemia

Question 13

Differential diagnosis of diverticulosis?

Answer 13

Colorectal cancer
IBD
Colonic polyps
Coeliac
Many more!

Question 14

What are the risk factors for developing diverticula?

Answer 14

Age
Constipation
Low fibre diet
Genetic predisposition
Connective tissue disorders

Question 15

What causes diverticulitis?

Answer 15

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

Question 16

What are the clinical features of diverticulitis?

Answer 16

Constant abdominal pain in left iliac fossa
Fever
Nausea
Malaise
Diarrhoea or constipation

Question 17

Investigations of diverticulitis?

Answer 17

Blood:

• raised white cell count
• raised CRP + ESR
• faecal calprotectin
• CEA, carcinoembryonic antigen (bowel Ca)

Abdominal exam: tenderness of left iliac fossa

Colonoscopy

Question 18

Treatment of diverticulitis?

Answer 18

Antibiotics!
Analgesia
IV fluids
Drainage if there’s an abscess

Surgery is indicated rarely

Question 19

What are some complications of diverticulitis?

Answer 19

Perforation of bowel

Haemorrhage

Fistula

Abscesses

Structures

Question 20

What are the clinical features of perforation of bowel?

Answer 20

Peritonitis (can be fatal)
Shock
Abdominal pain

Question 21

What are the clinical features of haemorrhage due to diverticulitis?

Answer 21

Sudden and painless usually
Massive rectal bleed, or slower bleed causing anaemia

Requires transfusion
Rescusitation