GI - diverticular disease

Question 1

Define diverticular disease?

Answer 1

diverticula (outpouchings of colonic mucosa through muscular layer) + Sx
(ASx = diverticulosis)

Question 2

Define diverticulitis

Answer 2

inflamed outpouchings + Sx

Question 3

Meckel’s diverticulum?

Answer 3

congenital diverticulum which usually presents in infancy, but can present in adults

Question 4

Patient presents with several months of altered bowel habit and L-sided colic pain relieved by defecation (some painless PR bleeds), bloating/flatulence, +/- N, C w/ D?

Answer 4

Diverticular disease

Question 5

If patient presents acutely with LIF pain ± guarding, D, PR mucus / blood, fever, ↑WCC, ↑CRP, anorexia, N, + V, may be preceded by several months of altered bowel habit?

Answer 5

Diverticulitis

Question 6

If patient presents with Sx of sudden onset pain and peritonitis, ileus +/- shock, with Hx diverticular disease?

Answer 6

Perforated diverticulitis

Question 7

Complications of peritonitis + Tx?

Answer 7

• perforation (40% die) laparotomy Hartmann’s procedure
• haemorrhage(sudden + painless) embolisation
• fistulae (pneumaturia/frothy wee + UTIs) colonic resection
• abscesses (swinging fever + ↑WCC +/- mass) if no localising Sx US for subphrenic abscess, Abx + CT-guided drainage
• strictures (lead to obstruction)

Question 8

Risk factors for diverticulitis?

Answer 8

age (>50), low fibre diet

Question 9

Ix for diverticulitis?

Answer 9

• FBC: ↑WCC
• CT abdo (best to confirm acute diverticulitis + complications)
• colonoscopy if doubt/suspected CA (but if acute, perforation risk)
• AXR: if perforation

Question 10

Tx if uncomplicated diverticular disease?

Answer 10

No Tx if no Sx

Otherwise high-fibre diet

Question 11

Tx diverticulitis?

Answer 11

• mild: oral Abx at home + fluid diet
• if Sx persist: analgesia, IV Abx + fluids, NBM
• if abscesses >3 cm (CT-guided aspiration percutaneous/transrectal)
• if perforation + peritonitis, sepsis, fistula, or obstruction: surgery

Question 12

classification to help guide management of complicated diverticular disease?

Answer 12

Hinchey: depending on abscess or peritonitis, Tx with Abx or laparoscopy

Question 13

Tx diverticular disease?

Answer 13

antispasmodics (mebeverine)

Question 14

when to do an Elective surgery to Tx diverticulitis?

Answer 14

fistula, recurrent bleeding, stenosis