diverticular disease Flashcards

1
Q

what is Diverticulosis?

A

the presence of diverticulae outpouchings of the colonic mucosa and submucosa through the muscular wall of the large bowel

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2
Q

what is diverticular disease?

A

diverticulosis associated with symptomatic complications e.g. haemorrhage, infection, fistulae

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3
Q

what is Diverticulitis?

A

acute inflammation and infection of colonic diverticulae

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4
Q

what is the aetiology of diverticulitis?

A

o Loss of stool bulk leads to the generation of high colonic intraluminal pressures to propel the stool out
o This, in turn, leads to the herniation of the mucosa and submucosa through the muscularis

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5
Q

where are diverticulae most commonly found?

A
  1. sigmoid

2. descending colon

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6
Q

what are the risk factors for diverticular disease?

A
o	Age 
o	Lack of fibre 
o	Obesity 
o	Sedentary life-style 
o	Smoking 
o	NSAID use
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7
Q

epidemiology of diverticular disease?

A
  • Diverticular disease is VERY COMMON

- right sided more common in asians

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8
Q

what are the presenting symptoms of diverticular disease?

A
  • Severe left iliac fossa pain and tenderness
  • Anorexia, nausea and vomiting
  • Diarrhoea and constipation
  • Features of infection (pyrexia, raised WBC and CRP)
  • PR bleeding
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9
Q

signs of diverticular disease on physical examination?

A
  • Tender LIF (may be a palpable mass)
  • Signs of local or generalised peritonitis if a diverticulum has perforated
  • Pyrexia
  • Tachycardia
  • Guarding, rigidity rebound tenderness
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10
Q

what are the general investigations for diverticular disease?

A

• Bloods:
o FBC: increased WCC, increased CRP
o Check clotting and cross-match if bleeding

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11
Q

what are the non acute investigations for diverticular disease?

A

o CT
o CT cologram
o Barium enema
o Can be difficult to exclude cancer.

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12
Q

what are the acute investigations for diverticular disease?

A

o Plain abdominal films and erect chest X-Ray for checking perforation
o Abdominal CT scan with oral and IV contrast can identify abscesses

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13
Q

how to classify diverticular disease?

A

Hinchey classification

I II III IV

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14
Q

managing asymptomatic diverticular disease?

A

o Soluble high-fibre diet (20-30 g/day)

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15
Q

managing mild diverticular disease?

A

o Antibiotics
o Liquid diet
o Hydration
o Can be treated at home for 72 hours, if persisting admit to hospital

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16
Q

managing severe diverticular disease?

A

o Peri colonic abscesses should be drained either surgically or radiologically
o Recurrent episodes of acute diverticulosis requiring hospitalisation are an indication for a segmental resection
o Hinchey IV perforations require resection and usually a stoma
o Less severe perforations can be managed by laparoscopic washout and drain insertion

17
Q

Identify the possible complications of diverticular disease

A
  • Diverticulitis
  • Pericolic abscess
  • Perforation
  • Faecal peritonitis
  • Colonic obstruction
  • Fistula formation (bladder, small intestine, vagina)
  • Haemorrhage
18
Q

prognosis of patients with diverticular disease

A

• 10-25% have one or more episodes of diverticulitis