General: Diverticular Disease Flashcards

1
Q

Outline the pathophysiology of diverticular disease

A

Aging bowel = weakened in certain areas

Movement of stool = increase in luminal pressure = outpouching in mucosa through weaker areas = bowel contents, bacteria, can accumulate

Diverticulum when inflamed can perforate

Composed only of mucosa, most commonly in the descending and sigmoid colon

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2
Q

Define diverticulosis

A

the presence of diverticulum

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3
Q

Define diverticular disease

A

symptomatic diverticulum

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4
Q

Define diverticulitis

A

inflammation of the diverticulum

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5
Q

What are the risk factors for diverticular disease?

A

Low dietary fibre

Obesity

Smoking

FH

NSAIDs

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6
Q

How does each type of diverticular present?

A

Diverticulosis = mainly asymptomatic

Diverticular disease = L lower abdo pain (colicky, relieved by defecation), altered bowel habit, nausea, flatulence

Diverticulitis = abdo pain (generalised peritonitis), LIF pain (localised peritonism), painless PR bleeding, anorexia, nausea, vomiting, pyrexia

Perforation = signs of localised peritonism or generalised peritonitis

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7
Q

What investigations should never be performed on suspected cases of diverticulitis?

A

Sigmoidoscopy or colonoscopy should never be performed in any presenting cases of suspected diverticulitis, due to the increased risk of perforation

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8
Q

What are the investigations for suspected diverticular disease?

A

Routine bloods = FBC, CRP, g+s

Blood gas

Urine dipstick = rule out urological causes

Flexible sigmoidoscopy = identify any obvious rectosigmoidal lesion

eCXR = if perforation is suspected

CT abdo-pelvis

Contrast studies = investigate if fistulas have developed

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9
Q

How should diverticular disease be managed?

A

Bloods + lactate

Analgesia

Encourage intake of clear fluids

Broad spec IV Abx

IV fluids

Bowel rest, low fibre diet

Perforation, sepsis, failure to improve = bowel resection (hartmanns), laproscopic peritoneal lavage (washout)

Grading determines further Mx - Hinchey classification

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10
Q

Describe a hartmens procedure

A

surgical resection of the rectosigmoid colon

closure of the anorectal stump

formation of an end colostomy

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11
Q

What are the possible complications of diverticular disease?

A

Pericolic abscess = Abx, bowel rest, CT guided drainage

Fistula = require surgical resection/repair

Bowel obstruction = secondary to stricture formation, needs stenting or bowel resection

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12
Q

What are the low risk geographic areas, and conversely what are the high risk geographic areas for diverticular disease?

A

Low = Developing world = africa, asia (0.5%)

High = Western countries = US, europe, australia (60% at 60yrs)

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13
Q

What is the purported reason for the observed difference in risk in western and developing world countries, regarding diverticular disease?

A

The western diet is particularly deficient in fibre = longer transit time = increased intraluminal pressure

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