Diverticulum

Question 1

what is a true diverticulum?

Answer 1

an outpouching covered by all the layers of the bowel wall (e.g. Meckels diverticulum, jejunal diverticulum)

Question 2

what is a false diverticulum?

Answer 2

lacking the normal muscle coat of the bowel (e.g. colonic diverticula)

Question 3

What are diverticula?

Answer 3

plural of diverticulum

Question 4

What is diverticulosis?

Answer 4

the presence of (usually colonic) diverticula

Question 5

What is diverticular disease?

Answer 5

complicated diverticulosis, the presence of symptoms resulting from the existence of diverticula in the large intestine

Question 6

What is diverticulitis?

Answer 6

inflammation of a diverticulum

Question 7

what are the causes of diverticulosis?

Answer 7

• Low fibre diet
• Structural abnormalities: Marfans, Ehlers-Danlos, polycystic kidney disease
• Abnormal motility and increased intraluminal pressure
• Smoking, NSAIDS?

Question 8

what is the process of diverticula formation?

Answer 8

hypertrophy of the sigmoid colon causes spams and increase pressure leading to herniation between the teniae coli alongside blood vessels

Question 9

what is acute diverticulosis?

Answer 9

If something is stuck inside an diverticula can lead to infection

Question 10

what are the different presentations of diverticula?

Answer 10

Diverticulosis
Diverticular Disease
Diverticulitis
Large Bowel Obstruction
Haemorrhage

Question 11

what are the symptoms of diverticulosis?

Answer 11

symptomless

Question 12

what are the symptoms of diverticular disease

Answer 12

erratic bowel habits (diarrhoea)

left iliac fossa pain (colicky)

Question 13

what can diverticulitis result in?

Answer 13

perforation

Question 14

Where can the bowel perforate in diverticulitis?

Answer 14

o Peritoneal cavity to cause peritonitis
o Pericolic tissues forming a pericolic abscess
o Adjacent structures forming fistula

Question 15

what are the symptoms of a bladder fistula in diverticulitis?

Answer 15

cystitis, pneumaturia, recurrent UTIs, faecal matter in urine

Question 16

what are the symptoms of small bowel fistula in diverticular disease?

Answer 16

diarrhoea

Question 17

what are the symptoms of a large bowel obstruction?

Answer 17

absolute constipation, colicky bowel pain, vomiting

Question 18

what are the investigations used in diverticula disease?

Answer 18

clinical examination
barium enema
ultrasound
sigmoidoscopy

Question 19

when is sigmoidoscopy useful in diverticula disease investigations?

Answer 19

if other investigations have been inconclusive

Question 20

what is the investigation of choice in diverticula disease?

Answer 20

barium enema

Question 21

when should barium enemas not be used in diverticula disease investigations?

Answer 21

should not be used if there are active complications.

Question 22

what is the management of asymptomatic diverticular disease?

Answer 22

no direct treatment – recommend high fibre diet and high fluid intake

Question 23

what is the management of symptomatic diverticular disease?

Answer 23

o Analgesics
o Laxatives
o Anticholinergics
o Surgery

Question 24

what are the clinical features of acute diverticulitis?

Answer 24

o	Left iliac fossa pain 
o	Malaise / fever
o	Palpable mass
o	Abdominal distension
o	Tachycardia
o	“left sided appendicitis”

Question 25

what investigations are used for acute diverticulitis?

Answer 25

CRP and ESR | US/CT

Question 26

what will the CRP and ESR be in acute diverticulitis?

Answer 26

raised

Question 27

what will a US/CT show in acute diverticulitis?

Answer 27

can show wall thickening, diverticula, and also abscess or perforation

Question 28

what is the management of acute diverticulits?

Answer 28

o Antibiotics – metronidazole o Fluids o Analgesia

Question 29

what is the Rule of 2 in Meckels Diverticulum

Answer 29

* 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

Question 30

what is the cause of Merkels Diverticulum?

Answer 30

remnant of the vitellointestinal duct becoming infected or obstructed

Question 31

where is Merkels Diverticulum located?

Answer 31

Lies on the antimesenteric border of the ileum, distal ileum

Question 32

what does Merkels Diverticulum contain?

Answer 32

Contains ectopic ileal, gastric or pancreatic mucosa - risk of peptic ulceration

Question 33

what is the blood supply for Merkels Diverticulum?

Answer 33

omphalomesenteric artery

Question 34

what are the symptoms of Merkels Diverticulum?

Answer 34

``` abdominal pain mimicking appendicitis rectal bleeding intestinal obstruction or volvulus asymptomatic perforation - peritonitis peptic ulcer - melaena Raspberry tumour at the umbilicus ```

Question 35

how can merkels diverticulum be diagnosed?

Answer 35

* technetium scan * barium follow-through or small bowel enema * CT

Question 36

how can Merkels be treatment?

Answer 36

• Resection of the diverticulum

Question 37

what are the indications for surgical resection in Merkels Diverticulum?

Answer 37

if narrow neck or symptomatic

Question 38

what are the complications of Merkels?

Answer 38

* haemorrhage * intestinal obstruction * diverticulitis * umbilical anomalies * neoplasm