Week 6- Diverticular disease

Question 1

what is diverticular disease?

Answer 1

when someone has pouches that stick out of normally the large intestine and it is asymptomatic and occurs in the gut usually the colon

Question 2

when would you have problems with divericular disease?

Answer 2

when you have diverticulitis which is the inflammed diverticula

Question 3

what is diverticulosis?

Answer 3

– condition where uninflammed diverticula

Question 4

what is the epiemiology of divercular disease?

Answer 4

• very common in industrialised countries e.g. westernisation increases incidences due to highly refined diets
• 5% of patients develop divericulitis
• 15-25% patients with diverculitis develop complications and require surgery

Question 5

what is the prevalence of Diverticular disease?

Answer 5

• equal in male and female

- increases with age

Question 6

what is the aetiology of diverticular disease?

Answer 6

unknown, but due to increase in intraluminal pressure and weakening of muscle wall though to be primary care cause

Question 7

what are some factors that are thought to be involved in diverticular disease?

Answer 7

• genetics=Left-sided diverticula predominate in US, Right-sided predominant in Asians
• dietary factors= Associated with a low fibre diet and constipation, Associated with obesity

Question 8

what is the pathogenesis of divercular disease?

Answer 8

Colonic muscular hypertrophy results in narrowing of
lumen and formation of small chamber with high pressure
and subsequent diverticula

Question 9

what is diverticulitis occurs when…?

Answer 9

-fecal material or undigested food collect in diverticula and cause obstruction
- mucus secretion and normal bacterial overgrowth lead to distension of diverticula
-increase in intraluminal pressure and stuck food particles may also damage diverticula wall, resulting in inflammation and necrosis and perforation
-recurrent attacks lead to scar tissue formation and lumen
narrowing

Question 10

what are some clinical features for divercular disease

Answer 10

-maybe Asymptomatic or symptomatic depending on if they have diverticulitis and the severity of inflammation
-very similar symptoms to inflammatory bowel disease so need to do a diagnostic test to see pouches
-Pain – lower left abdomen in 70% patients, often crampy
• Fever
• Malaise
• Nausea and vomiting
• Flatulence and bloating
• Constipation
• Diarrhoea
• Lower GI bleeding, blood in feces

Question 11

what is some management for diverticular disease?

Answer 11

-high fibre diet to help decrease transit time in the gut
-bran supplements
-bulk-forming laxatives
-anti-spasmodics when colic eg alverine, atropine
sulphate
-Anti-motility drugs to slow transit time eg codeine,
diphenoxylate and loperamide should NOT be used

Question 12

what is some management for mild Diverticuliti ?

Answer 12

-clear liquid diet try to reintrodcue food after symptoms subside and anti-microbials 7-10 days of oral-spectrum

Question 13

what is some management for serve diverticulitis?

Answer 13

this is for systematic involvemnt or complications
- Hospitalisation
– Bowel rest
– iv fluids and broad spectrum anti-microbials
– Pain management eg morphine
– Once symptoms subside, clear liquid diet and food
reintroduction slowly eventually to high fibre diet
– Complications may be treated with surgery eg fistulas,
abscesses