General: Diverticular Disease Flashcards
Outline the pathophysiology of diverticular disease
Aging bowel = weakened in certain areas
Movement of stool = increase in luminal pressure = outpouching in mucosa through weaker areas = bowel contents, bacteria, can accumulate
Diverticulum when inflamed can perforate
Composed only of mucosa, most commonly in the descending and sigmoid colon
Define diverticulosis
the presence of diverticulum
Define diverticular disease
symptomatic diverticulum
Define diverticulitis
inflammation of the diverticulum
What are the risk factors for diverticular disease?
Low dietary fibre
Obesity
Smoking
FH
NSAIDs
How does each type of diverticular present?
Diverticulosis = mainly asymptomatic
Diverticular disease = L lower abdo pain (colicky, relieved by defecation), altered bowel habit, nausea, flatulence
Diverticulitis = abdo pain (generalised peritonitis), LIF pain (localised peritonism), painless PR bleeding, anorexia, nausea, vomiting, pyrexia
Perforation = signs of localised peritonism or generalised peritonitis
What investigations should never be performed on suspected cases of diverticulitis?
Sigmoidoscopy or colonoscopy should never be performed in any presenting cases of suspected diverticulitis, due to the increased risk of perforation
What are the investigations for suspected diverticular disease?
Routine bloods = FBC, CRP, g+s
Blood gas
Urine dipstick = rule out urological causes
Flexible sigmoidoscopy = identify any obvious rectosigmoidal lesion
eCXR = if perforation is suspected
CT abdo-pelvis
Contrast studies = investigate if fistulas have developed
How should diverticular disease be managed?
Bloods + lactate
Analgesia
Encourage intake of clear fluids
Broad spec IV Abx
IV fluids
Bowel rest, low fibre diet
Perforation, sepsis, failure to improve = bowel resection (hartmanns), laproscopic peritoneal lavage (washout)
Grading determines further Mx - Hinchey classification
Describe a hartmens procedure
surgical resection of the rectosigmoid colon
closure of the anorectal stump
formation of an end colostomy
What are the possible complications of diverticular disease?
Pericolic abscess = Abx, bowel rest, CT guided drainage
Fistula = require surgical resection/repair
Bowel obstruction = secondary to stricture formation, needs stenting or bowel resection
What are the low risk geographic areas, and conversely what are the high risk geographic areas for diverticular disease?
Low = Developing world = africa, asia (0.5%)
High = Western countries = US, europe, australia (60% at 60yrs)
What is the purported reason for the observed difference in risk in western and developing world countries, regarding diverticular disease?
The western diet is particularly deficient in fibre = longer transit time = increased intraluminal pressure
