Perforated Diverticulitis, Perforated Peptic Ulcer

Question 1

What is a diverticulum?

Answer 1

Diverticulum - blind ending pouch (outpocketing from bowel) whch is an area of weakness. They are formed due to increased luminal pressure.

Question 2

What is perforated diverticulitis?

Answer 2

Condition common in Western societies.

Increased pressure in areas of weakness causes mucosa to be driven through. This can then become infected and perforate

Question 3

What causes imflammation and haemorrhage of diverticula?

Answer 3

Stool –> erosion of mucosa–> hyperemic colon –> inflammation.

Further erosion –> perforation and haemorrhage

Question 4

What is the clinical presentation of perforated diverticulitis?

Answer 4

• Severe left iliac fossa pain
• Nausea, loss of appetite, constipation
• Patients are usually pyrexial and have a tachycardia
• There may be a tender indistinct mass lying parallel to the inguinal ligament.

Question 5

Name 1 chronic and 3 acute causes of peptic ulcers.

Answer 5

Chronic - Helicobacter infection

Acute - NSAIDs, alcohol, smoking.

Chronic can still cause an acute presentation.

Question 6

What percentage of patients get peptic ulcers? How deadly is rupture of peptic ulcers?

Answer 6

Occurs in 2% of patients

2/3 of ulcer deaths are due to rupture of ulcers. Rupture of an ulcer is rarely the 1st indication (pain comes first)

Question 7

What is the clinical presentation of perforated peptic ulcer?

Answer 7

• Epigastric pain
• Patients with acute peptic ulceration present with acute pain of short duration but may have had previous similar episodes interspersed with periods of relief which last for many months or even years.