General Surgery/GIT / Diverticular Disease Flashcards
What are diverticula?
Sac-like protrusions of the colon wall
What is the difference between diverticulosis and diverticulitis?
- Diverticulosis describes the presence of diverticula, while diverticulitis is inflammation of those diverticula.
What is the prevalence of diverticular disease?
- Less than 5% at age 40
- 65% at age 85
Presentation of Diverticulosis
- asymptomatic 70%
- Develop diverticulitis 20%
- Develop diverticular bleeding 10%
What causes diverticular bleeding?
- A penetrating arterial vessel becomes draped over a diverticulum as it forms (with only mucosa separating the vessel from the lumen, and the vasa recta ruptures into the lumen).
Diverticular bleeding is painful. True or false?
False. It is painless and usually self-limited.
Why are the diverticuli called false diverticula?
They don’t contain all the layers of the colonic wall (mucosa and submucosa herniate through the muscle layer and are covered only by serosa)
Where do diverticula develop?
At points of weakness, where the vasa recta penetrates the circular muscle layer
Where in the colon do patients tend to get diverticula?
- 95% are sigmoid diverticula
- 35% have disease proximal to the sigmoid
What is thought to cause diverticula?
Increased colon pressure by enhanced peristaltic contractions and a low-fiber diet
What causes diverticulitis?
Micro-perforation of diverticula by increased intraluminal pressure or inspissated food particles, resulting in inflammation and focal necrosis
What are the classic symptoms of diverticulitis?
- Left lower quadrant (LLQ) pain
- with or without nausea and vomiting
- constipation
- diarrhea
- irritative urinary symptoms
What are the physical exam findings suggestive of diverticulitis?
- LLQ tenderness
- abdominal distention
- tender
- palpable mass
- low-grade fever
What are the key lab findings in diverticulitis?
- Mild leukocytosis
- normal LFTs
- sterile pyuria
What are the key CT findings in diverticulitis?
- Increased soft tissue density within pericolic fat, colonic diverticula, bowel wall thickening
