FN: Divertivular disease Flashcards
Diverticulum
Out-pouching of tubuar structure
True diverticulum
Composed of complete wall (e.e. Meckels)
False diverticulum
Composed of mucosa only (pharyngeal, colonic)
Diverticular disease
Symptomatc diverticulosis
Diverticulitis
Inflammation of diverticular
Epi
30% westerners have diverticulosis by 60yrs
F>M
Path
- Association with raised intraluminal pressure - low fibre diet: n osmotic effect to keep stool wet
- Mucosa herniates through muscularis propria at points of weakness where perforating arteries enter
- Most commonly loacted in sigmoid colon
- Commoner in obese pts.
- -> Uniting factors in Saints triad
Saints triad
Hiatus hernia
Cholelithiasis
Diverticular disease
Symptoms of Diverticular disease
- Altered bowel habit ± left-sided colic - relieved by defecation
- Nausea
- Flatulence
Rx
High fibre diet, mebeverine may help
Elective resectino for chronic pain
Diverticulitis
Inspissated faeces - obstruction of diverticulum
Elderly pt. with previous Hx of constipation
Presentation
Andominal pain and tenderness
- typically LIF
- Localised peritonitis
Pyrexia
Investigations
Bloods
Imaging
Endoscopy
Bloods shows
Raised WCC
Raised CRP/ESR
Amylase
G+S/x-match
Imagng
Erect CXR: look for perforation
AXR: fluid level/air in bowel wall
Contrast CT
Gastrogaffin enema
Endoscopy
Flexi sig
ColonoscopyL not in acute attack
Grading system
Hinchey grading
Managemt of acute Diverticulitis
Mild attacs
Admit if
Medical
surgical
Mild attacks Rx
Can be treated at home with bwel rest (luids only) and augmentin ! metronidazole
Admit if
Unwell
Fluids cnat be tolerated
Pain cant be controlled
Medical Rx
NBM IV fluids Analgesia Antibiotics: cefuroxime + metronidazole Most cases settle
Surgical indications
Perforation
Large haemorhage
Stricture - obstruction
Surgical procedure
Hartmanns to resect disease bowel
Other Complications
Perforation Haemorrhage Abscess Fistulae Strictures
Perforation
sudden onset pain ! preceding diverticulitis
Generalised peritonitis and shock
CXR perforation
Free air under diaphragm
Perforation Rx
Hartmanns
Haemorrhage
Sudden, painless bright red PR bleed
Investigations for Haemorrhage
Mesenteric angiography or colonoscopy
Treatment of Hemorrhage
Usually stops spontaneously May need transfusion Colonscopy ± diathermy/adrenaline Embolisation Resection
Abscess
Walled off perforation
swinging fever
Localising signs e.g. boggy rectal mass
Leukocytosis
Treatment of abcess
Abx +CT/US-guided drainage
Fistulae
Enterocolic
Colovaginal
Colovesicular: pneumaturia + intractable UTIs
Fistulae Rx
Resection
Strictures
After diverticulitis, colon may heal with fibrous strictures
Stricture management
Resectio (usually with primary anastomosis)
Stenting
