Diverticulum Flashcards
what is a true diverticulum?
an outpouching covered by all the layers of the bowel wall (e.g. Meckels diverticulum, jejunal diverticulum)
what is a false diverticulum?
lacking the normal muscle coat of the bowel (e.g. colonic diverticula)
What are diverticula?
plural of diverticulum
What is diverticulosis?
the presence of (usually colonic) diverticula
What is diverticular disease?
complicated diverticulosis, the presence of symptoms resulting from the existence of diverticula in the large intestine
What is diverticulitis?
inflammation of a diverticulum
what are the causes of diverticulosis?
- Low fibre diet
- Structural abnormalities: Marfans, Ehlers-Danlos, polycystic kidney disease
- Abnormal motility and increased intraluminal pressure
- Smoking, NSAIDS?
what is the process of diverticula formation?
hypertrophy of the sigmoid colon causes spams and increase pressure leading to herniation between the teniae coli alongside blood vessels
what is acute diverticulosis?
If something is stuck inside an diverticula can lead to infection
what are the different presentations of diverticula?
Diverticulosis Diverticular Disease Diverticulitis Large Bowel Obstruction Haemorrhage
what are the symptoms of diverticulosis?
symptomless
what are the symptoms of diverticular disease
erratic bowel habits (diarrhoea)
left iliac fossa pain (colicky)
what can diverticulitis result in?
perforation
Where can the bowel perforate in diverticulitis?
o Peritoneal cavity to cause peritonitis
o Pericolic tissues forming a pericolic abscess
o Adjacent structures forming fistula
what are the symptoms of a bladder fistula in diverticulitis?
cystitis, pneumaturia, recurrent UTIs, faecal matter in urine
what are the symptoms of small bowel fistula in diverticular disease?
diarrhoea
what are the symptoms of a large bowel obstruction?
absolute constipation, colicky bowel pain, vomiting
what are the investigations used in diverticula disease?
clinical examination
barium enema
ultrasound
sigmoidoscopy
when is sigmoidoscopy useful in diverticula disease investigations?
if other investigations have been inconclusive
what is the investigation of choice in diverticula disease?
barium enema
when should barium enemas not be used in diverticula disease investigations?
should not be used if there are active complications.
what is the management of asymptomatic diverticular disease?
no direct treatment – recommend high fibre diet and high fluid intake
what is the management of symptomatic diverticular disease?
o Analgesics
o Laxatives
o Anticholinergics
o Surgery
what are the clinical features of acute diverticulitis?
o Left iliac fossa pain o Malaise / fever o Palpable mass o Abdominal distension o Tachycardia o “left sided appendicitis”
what investigations are used for acute diverticulitis?
CRP and ESR
US/CT
what will the CRP and ESR be in acute diverticulitis?
raised
what will a US/CT show in acute diverticulitis?
can show wall thickening, diverticula, and also abscess or perforation
what is the management of acute diverticulits?
o Antibiotics – metronidazole
o Fluids
o Analgesia
what is the Rule of 2 in Meckels Diverticulum
- 2% (of the population)
- 2 feet (proximal to the ileocecal valve)
- 2 inches (in length)
- 2 types of common ectopic tissue (gastric and pancreatic)
- 2 years is the most common age at clinical presentation
- 2:1 male: female ratio
what is the cause of Merkels Diverticulum?
remnant of the vitellointestinal duct becoming infected or obstructed
where is Merkels Diverticulum located?
Lies on the antimesenteric border of the ileum, distal ileum
what does Merkels Diverticulum contain?
Contains ectopic ileal, gastric or pancreatic mucosa - risk of peptic ulceration
what is the blood supply for Merkels Diverticulum?
omphalomesenteric artery
what are the symptoms of Merkels Diverticulum?
abdominal pain mimicking appendicitis rectal bleeding intestinal obstruction or volvulus asymptomatic perforation - peritonitis peptic ulcer - melaena Raspberry tumour at the umbilicus
how can merkels diverticulum be diagnosed?
- technetium scan
- barium follow-through or small bowel enema
- CT
how can Merkels be treatment?
• Resection of the diverticulum
what are the indications for surgical resection in Merkels Diverticulum?
if narrow neck or symptomatic
what are the complications of Merkels?
- haemorrhage
- intestinal obstruction
- diverticulitis
- umbilical anomalies
- neoplasm
