Diverticular disease and diverticulitis

Question 1

What is Diverticulosis?

Answer 1

An asymptomatic condition where diverticula is present.

Question 2

What is Diverticula?

Answer 2

Small pouches protruding from the walls of the large intestine.

Question 3

What’s the prevalence of diverticulosis?

Answer 3

It’s age dependent with the majority of patients aged 40 and over

Question 4

What’s diverticular disease?

Answer 4

A condition where diverticula are present with symptoms.
Symptoms can overlap with colitis, IBS and malignancy

Question 5

Symptoms of Diverticular disease?

Answer 5

Abdominal tenderness, mild intermittent lower abdominal pain with constipation, diarrhoea, or ocasional rectal bleeds.

Question 6

What’s acute diverticulitis?

Answer 6

When diverticula suddenly becomes inflamed or infected.

Question 7

Symptoms of acute diverticulitis?

Answer 7

Constant lower abdominal pain (usually severe) together with features such as fever, a sudden change in bowel habits and significant rectal bleeding, lower abdominal tenderness, palpable abdominal mass.

Question 8

What is complicated acute diverticulitis and the symptoms?

Answer 8

It refers to diverticulitis associated with complications such as abscess, bowel perforation, and peritonitis, fistula, intestinal obstruction, haemorrhage or sepsis.

Question 9

What is the aim of treatment for diverticular disease?

Answer 9

Improve quality of life, manage episodes of acute diverticulitis and reduce risk of recurrence and complications

Question 10

What must patients be told as part of non-drug management?

Answer 10

Patients must be told of: diet and lifestyle changes, the course of the disease, likelihood of progression, symptoms and symptom management, investigation and treatment options.

Question 11

Non-drug management for diverticular disease?

Answer 11

Eating a healthy, balanced diet including whole grains, fruits and vegetables.

A gradual increase of dietary fibre to minimize flatuence and bloating. Patient increasing dietary fibre should drink an adequate amount of fluid, especially with risk of dehydration.

Patients should be told, it can take weeks for the benefits of increasing fibre to be achieved; but if tolerated, should be continued for life

Question 12

What may be the treatment for complicated acute diverticulitis?

Answer 12

Emergency or elective surgical management

Question 13

Treatment for diverticulosis?

Answer 13

Because its an asymptomatic condition, there’s no specific treatment.

So just bulk forming laxatives for patients with constipation

Question 14

Examples of bulk forming laxative?

Answer 14

• Fybogel (ispaghula husk)
• Methylcellulose

Question 15

Examples of Osmotic laxatives?

Answer 15

• Lactulose (also called by the brand names Duphalac and Lactugal)
• Macrogol - Movicol, Laxido, CosmoCol, Molaxole and Molative
• Polyethylene glycol

Question 16

Examples of stimulant laxatives?

Answer 16

• Bisacodyl (also called by the brand name Dulcolax)
• Senna
• Sodium picosulfate

Question 17

Example of Poo-softener laxative?

Answer 17

• Arachis oil
• Docusate

Question 18

How do bulk forming laxatives work?

Answer 18

Bulk-forming laxatives work by increasing the “bulk” or weight of poo, which in turn stimulates your bowel.

Question 19

How do Osmotic laxatives work?

Answer 19

Osmotic laxatives draw water from the rest of the body into your bowel to soften poo and make it easier to pass.

They take 2-3 days to work.

Question 20

How do stimulant laxatives work?

Answer 20

These stimulate the muscles that line your gut, helping them to move poo along to your back passage.

They take 6-12 hours

Question 21

How do poo-softener laxatives work?

Answer 21

This type of laxative works by letting water into poo to soften it and make it easier to pass.

Question 22

What medications can patients with diverticular disease not use?

Answer 22

• Antibacterials
• Non-steroidal anti-inflammatory drugs
• Opioid analgesics

Question 23

Treatment for diverticular disease?

Answer 23

If a high-fibre diet is unsuitable, or there is persistent constipation or diarrhoea, then use bulk-forming laxative.

Simple analgesia such as paracetamol can be used for ongoing abdominal pain and antispasmodics can be used for abdominal cramps.

Question 24

If any of the drug treatment doesn’t work and symptoms persist, what should be considered?

Answer 24

An alternative treatment

Question 25

Drug treatment for acute diverticulitis?

Answer 25

Simple analgesia such as paracetamol - to patients who are systemically well.

But just watch and wait and don’t prescribe antibacterial. Advise patient to come back if symptoms persist or worsen.

Question 26

What should not be given for patients with recurrent acute diverticulitis?

Answer 26

Aminosalicylates or prophylactic antibacterials