Diverticultis Flashcards
What is the main risk factor for diverticular disease?
Age over 50 years and low dietary fiber are the main risk factors
Describe the pathophysiology of diverticular disease.
In the presence of low dietary fiber, the colon muscles must work harder to move feces along, causing high pressures in the colon. This leads to the formation of out-pouchings in the mucosa, known as diverticula
What are the clinical presentations of symptomatic diverticular disease?
Left iliac fossa pain/tenderness
Altered bowel habit.
Approximately 75% of symptomatic cases experience at least one episode of diverticulitis, characterized by pain, nausea, and vomiting.
What investigations are conducted for diverticular disease?
Barium enema
Sigmoidoscopy
Barium enema is preferred initially, followed by sigmoidoscopy if the results are inconclusive
How is asymptomatic diverticular disease managed?
Asymptomatic cases are managed by recommending a high-fiber diet and increased fluid intake.
Outline the management of symptomatic diverticular disease
Symptomatic cases are managed with analgesics and, if necessary, laxatives (excluding stimulant laxatives). Severe cases may require surgical resection of the sigmoid colon
What are the potential complications of diverticular disease?
Inflammation
Rupture
Abscess formation
Fistulae
Massive bleeding.
What percentage of people with diverticula remain asymptomatic?
Approximately 75% of individuals with diverticula have asymptomatic diverticulosis.
What is the preferred management for severe symptomatic diverticular disease?
Surgical resection of the sigmoid colon
What are the symptoms of diverticulitis?
Pain
Nausea
Vomiting
Often localized to the left iliac fossa.
What are the clinical manifestations of accute diverticulitis? (signs + symptoms)
Lower abdominal pain
Often localized to the left iliac fossa Diarrhea with or without rectal bleeding
Malaise
Fever
Signs may include a palpable mass, abdominal distension, and tachycardia
What causes inflammation in accute diverticulitis?
Inflammation in diverticulitis is caused by micro-perforation of a diverticulum.
What investigations are conducted for suspected acute diverticulitis?
(CT) scans and blood tests
Particularly with elevated C-reactive protein (CRP) levels
How is simple acute diverticulitis managed?
Simple diverticulitis is managed with fluids (oral or intravenous) and antibiotics (oral
What management strategies are employed for complicated acute diverticulitis?
Hartmann’s procedure
Abscess - drainage
Explain Hartmann’s procedure
sigmoid colon removed, and colostomy inserted
What are some examples of abscess-drainage procedures
(percutaneous, laparoscopic lavage and drainage)
Explain what is percutaneous drainage
Involves using a needle or catheter to drain fluid or pus from an abscess or collection.
Commonly performed under imaging guidance (ultrasound or CT scan).
Relieves symptoms, reduces abscess size, and promotes healing
Explain what is laparoscopic lavage and drainage
Minimally invasive surgical procedure for complicated diverticulitis.
Small incisions are made in the abdomen, a laparoscope is inserted for visualization.
Irrigation of the abdominal cavity with saline (lavage) to clean and remove pus or debris.
Drainage tubes are inserted to allow continuous drainage of fluid or pus.
Helps control infection, and inflammation, and reduces complications.
A 77-year-old female patient presents to her GP with shortness of breath that has developed acutely over the past few hours, with ‘stabbing’ chest pain. She was discharged from the hospital 8 days ago with antibiotics following an episode of diverticulitis. On examination, she is tachycardic (HR: 104 bpm) and tachypnoeic (RR: 27). In addition, her right leg is swollen and the calf is tender on palpation. The GP arranges for the patient to be admitted. What single investigation will confirm the most likely cause of her acute breathlessness?
CT pulmonary angiography (CTPA)
