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