Diverticulitis

Question 1

What is the difference between diverticulosis, diverticular disease, and diverticulitis?

Answer 1

diverticulosis = formation of diverticula, herniation of mucosa and submucosa through muscular layer of the colonic wall - asymptomatic and causes no problems

Diverticular disease = any clinical state caused by symptoms pertaining to diverticula

Diverticulitis = inflammation of the diverticula

Question 2

What RFs are there for diverticulitis?

Answer 2

low fibre intake (increases interstitial transit time, decreases stool volume --> increased intraluminal pressure)
decreased physical activity
high red meat consumption
high alcohol and caffeine intake
steroids
NSAIDs
alterations in colonic wall structure 
connective tissue abnormalities

Question 3

What complications can occur because of diverticula?

Answer 3

fistulas
colorectal neoplasm
abscess
perforation
strictures
obstruction

Question 4

What are some S&S of acute diverticulitis?

Answer 4

LLQ pain
change in bowel habits
N&V
Constipation/diarrhoea
Flatulence
Bloating

Question 5

What additional symptoms would an acute diverticulitis patient present with if they also had ____?

a. peritonitis
b. fistula formation

Answer 5

a. generalised tenderness with rebound and guarding
distended abdomen
diminished or absent bowel sounds

b. purulent vaginal discharge
urinary tract symptoms if colovesicular fistulas

Question 6

What would diagnose diverticulitis on CT?

Answer 6

pericolic fat
colonic diverticula
bowel wall thickening
soft-tissue inflammatory masses
phlegmon 
abscesses

Question 7

How are patients with acute diverticulitis managed?

Answer 7

abx - amoxicillin/clavulanate or ciprofloxacin + metronidazole
high fibre diet
analgesia
supportive therapy

if there is acute rectal bleeding;
endoscopic haemostasis/angiographic embolization

if it’s recurrent;
colectomy laparoscopically