FN: Divertivular disease

Question 1

Diverticulum

Answer 1

Out-pouching of tubuar structure

Question 2

True diverticulum

Answer 2

Composed of complete wall (e.e. Meckels)

Question 3

False diverticulum

Answer 3

Composed of mucosa only (pharyngeal, colonic)

Question 4

Diverticular disease

Answer 4

Symptomatc diverticulosis

Question 5

Diverticulitis

Answer 5

Inflammation of diverticular

Question 6

Epi

Answer 6

30% westerners have diverticulosis by 60yrs

F>M

Question 7

Path

Answer 7

1. Association with raised intraluminal pressure - low fibre diet: n osmotic effect to keep stool wet
2. Mucosa herniates through muscularis propria at points of weakness where perforating arteries enter
3. Most commonly loacted in sigmoid colon
4. Commoner in obese pts.
   - -> Uniting factors in Saints triad

Question 8

Saints triad

Answer 8

Hiatus hernia
Cholelithiasis
Diverticular disease

Question 9

Symptoms of Diverticular disease

Answer 9

1. Altered bowel habit ± left-sided colic - relieved by defecation
2. Nausea
3. Flatulence

Question 10

Rx

Answer 10

High fibre diet, mebeverine may help

Elective resectino for chronic pain

Question 11

Diverticulitis

Answer 11

Inspissated faeces - obstruction of diverticulum

Elderly pt. with previous Hx of constipation

Question 12

Presentation

Answer 12

Andominal pain and tenderness

• typically LIF
• Localised peritonitis

Pyrexia

Question 13

Investigations

Answer 13

Bloods
Imaging
Endoscopy

Question 14

Bloods shows

Answer 14

Raised WCC
Raised CRP/ESR
Amylase
G+S/x-match

Question 15

Imagng

Answer 15

Erect CXR: look for perforation
AXR: fluid level/air in bowel wall
Contrast CT
Gastrogaffin enema

Question 16

Endoscopy

Answer 16

Flexi sig

ColonoscopyL not in acute attack

Question 17

Grading system

Answer 17

Hinchey grading

Question 18

Managemt of acute Diverticulitis

Answer 18

Mild attacs
Admit if
Medical
surgical

Question 19

Mild attacks Rx

Answer 19

Can be treated at home with bwel rest (luids only) and augmentin ! metronidazole

Question 20

Admit if

Answer 20

Unwell
Fluids cnat be tolerated
Pain cant be controlled

Question 21

Medical Rx

Answer 21

NBM
IV fluids
Analgesia
Antibiotics: cefuroxime + metronidazole
Most cases settle

Question 22

Surgical indications

Answer 22

Perforation
Large haemorhage
Stricture - obstruction

Question 23

Surgical procedure

Answer 23

Hartmanns to resect disease bowel

Question 24

Other Complications

Answer 24

Perforation
Haemorrhage
Abscess
Fistulae
Strictures

Question 25

Perforation

Answer 25

sudden onset pain ! preceding diverticulitis | Generalised peritonitis and shock

Question 26

CXR perforation

Answer 26

Free air under diaphragm

Question 27

Perforation Rx

Answer 27

Hartmanns

Question 28

Haemorrhage

Answer 28

Sudden, painless bright red PR bleed

Question 29

Investigations for Haemorrhage

Answer 29

Mesenteric angiography or colonoscopy

Question 30

Treatment of Hemorrhage

Answer 30

``` Usually stops spontaneously May need transfusion Colonscopy ± diathermy/adrenaline Embolisation Resection ```

Question 31

Abscess

Answer 31

Walled off perforation swinging fever Localising signs e.g. boggy rectal mass Leukocytosis

Question 32

Treatment of abcess

Answer 32

Abx +CT/US-guided drainage

Question 33

Fistulae

Answer 33

Enterocolic Colovaginal Colovesicular: pneumaturia + intractable UTIs

Question 34

Fistulae Rx

Answer 34

Resection

Question 35

Strictures

Answer 35

After diverticulitis, colon may heal with fibrous strictures

Question 36

Stricture management

Answer 36

Resectio (usually with primary anastomosis) | Stenting