Gen Surg: diverticular Flashcards
How can diverticulitis present?
Left lower quadrant pain, fever, N and Vom. PR bleeding and pain
What are diverticula?
Outpouchings of mucosa through weaker areas of the bowel wall.
Distinguish between diverticulosis, diverticular disease and diverticulitis
Diverticulosis = presence of diverticula. Diverticular disease = symptomatic diverticula. Diverticulitis = inflammation of the diverticula
What are RF for diverticula?
- Age,
- low fibre diet,
- obesity,
- Fhx,
- NSAID use.
How does diverticular disease present?
Intermittent lower abdo pain. Colicky. Pain relived by defecation, nausea, flatulence
How does acute diverticulitis present?
Acute abdo pain, sharp and localised to LIF. Worsened by movement. Localised tenderness, reduced appetite, pyrexia, nausea.
What is the pathophysiology of acute diverticulitis?
Bacteria grow in the outpouchings - causes inflammation. Can be simple, where its just inflam or complicated, where there is an abscess or perforation.
How may diverticular bleed present?
Painless PR bleed in diverticulosis. Painful PR bleed in diverticulitis.
How is diverticular disease managed?
Simple analgesia, increased fluid intake, colonoscopy to exclude malignancy.
What are complications of diverticular disease?
Acute diverticulitis, diverticular bleed.
What is conservative management of acute diverticulitis?
Abx, IV fluids, analgesia. Sx should improve in 2-3 days.
What surgical interventions are available for acute diverticulitis?
Hartmann’s procedure - sigmoid colostomy with formation of end colostomy.
What is a complication of acute diverticulitis?
Recurrance, strictures, fistula formation, diverticular bleed.
How is diverticular bleed managed?
Self limiting. Can do flexible sigmoidoscopy to check for malignancy.
