General surgery - diverticular disease Flashcards
What is diverticular disease?
Diverticulosis - presence of outpouchings from the bowel wall
Diverticulosis may be referred to as diverticular disease when patients experience symptoms.
Diverticulitis - inflammation of diverticula
Pathophysiology of diverticular disease
Increased pressure in the lumen overtime can cause gaps to form in weak areas of muscle in the bowel wall
These gaps allows the mucosa to herniate through
Presentation of diverticular disease and management of it
LIF pain
Constipation
Rectal bleeding
Management
- increase fibre in the diet
- Bulk forming laxatives e.g. isphagala husk
- Avoid stimulant laxatives
- Surgery in severe symptoms
Acute diverticulitis presentation
LIF pain Fever Diarrhoea N+V Rectal bleeding
Palpable abdominal mass (if an abscess has formed)
Raised inflammatory markers
Management of acute diverticulitis
Primary care:
- Oral Co-amoxiclav 500/125 TDS for 5 days (pen allergic can use Cefalexin plus metronidazole or trimethoprim)
- Clear fluids until symptoms improve (2-3d)
- Analgesia
- Follow up in 2 days
Secondary care
- Admit to hospital if severe pain, complications
- NBM/ clear fluids only
- IV Abx as per guidelines
- IV fluids
- Analgesia
- CT scan
- Urgent surgery for any complication
Complications of acute diverticulitis
Perforation
Peritonitis
Peridiverticular abscess
Large haemorrhage (needed blood transfusions
Fistula - e.g. between the colon and bladder/vagina
Ileus/obstruction
