Diverticultis

Question 1

What is the main risk factor for diverticular disease?

Answer 1

Age over 50 years and low dietary fiber are the main risk factors

Question 2

Describe the pathophysiology of diverticular disease.

Answer 2

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

Question 3

What are the clinical presentations of symptomatic diverticular disease?

Answer 3

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.

Question 4

What investigations are conducted for diverticular disease?

Answer 4

Barium enema
Sigmoidoscopy

Barium enema is preferred initially, followed by sigmoidoscopy if the results are inconclusive

Question 5

How is asymptomatic diverticular disease managed?

Answer 5

Asymptomatic cases are managed by recommending a high-fiber diet and increased fluid intake.

Question 6

Outline the management of symptomatic diverticular disease

Answer 6

Symptomatic cases are managed with analgesics and, if necessary, laxatives (excluding stimulant laxatives). Severe cases may require surgical resection of the sigmoid colon

Question 7

What are the potential complications of diverticular disease?

Answer 7

Inflammation
Rupture
Abscess formation
Fistulae
Massive bleeding.

Question 8

What percentage of people with diverticula remain asymptomatic?

Answer 8

Approximately 75% of individuals with diverticula have asymptomatic diverticulosis.

Question 9

What is the preferred management for severe symptomatic diverticular disease?

Answer 9

Surgical resection of the sigmoid colon

Question 10

What are the symptoms of diverticulitis?

Answer 10

Pain
Nausea
Vomiting
Often localized to the left iliac fossa.

Question 11

What are the clinical manifestations of accute diverticulitis? (signs + symptoms)

Answer 11

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

Question 12

What causes inflammation in accute diverticulitis?

Answer 12

Inflammation in diverticulitis is caused by micro-perforation of a diverticulum.

Question 13

What investigations are conducted for suspected acute diverticulitis?

Answer 13

(CT) scans and blood tests
Particularly with elevated C-reactive protein (CRP) levels

Question 14

How is simple acute diverticulitis managed?

Answer 14

Simple diverticulitis is managed with fluids (oral or intravenous) and antibiotics (oral

Question 15

What management strategies are employed for complicated acute diverticulitis?

Answer 15

Hartmann’s procedure
Abscess - drainage

Question 16

Explain Hartmann’s procedure

Answer 16

sigmoid colon removed, and colostomy inserted

Question 17

What are some examples of abscess-drainage procedures

Answer 17

(percutaneous, laparoscopic lavage and drainage)

Question 18

Explain what is percutaneous drainage

Answer 18

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

Question 19

Explain what is laparoscopic lavage and drainage

Answer 19

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.

Question 20

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?

Answer 20

CT pulmonary angiography (CTPA)