Acute Diverticulitis Flashcards
What is diverticulum
outpouching of the gut wall, usually at sites of entry or perforating arteries; can be acquired or congenital and may occur elsewhere but most important are colonic diverticula
What is diverticulosis
- diverticuli are present
What is diverticular disease
implies diverticula are symptomatic
what is diverticulitis
Inflammation of a diverticulum
Where does diverticulitis tend to occur
- Mostly within the sigmoid colon
- right sided and massive single diverticula can occur
What is the pathology of diverticulitis
- high intraluminal pressures (e.g. due to lack of dietary fibre) force the mucosa to herniate through the muscle layers of the gut at weak points adjacent to penetrating vessels
How do you diagnose acute diverticulitis
- CT abdomen - to confirm acute diverticulitis and can identify extent of disease and any complications
- colonoscopy - risks perforation in an acute setting
- AXR - may identify obstruction or perforation
What are the symptoms of diverticular disease
- Altered bowel habit +/- left sided colic relieved by defecation
- nausea
- flatulence
How do you treat diverticular disease
- Antispasmodics
- Surgical resection
What are the symptoms of diverticulitis
- alterated bowel habit
- nausea
- flatulence
- fever
- WCC increase
- increase in CRP/ESR
- tender colon +/- localised or generalised peritoneum
At what stage do you need surgery for diverticulitis
- Stage 1 = pericolic or mesenteric abscess = surgery rarely needed
- Stage 2 = walled off pelvic abscess = may resolve without surgery
- Stage 3 = generalised purulent peritonitis = surgery required
- Stage 4 = generalised faecal peritonitis = surgery required
What are the complications of diverticulitis
- perforation
- haemorrhage
- fistulae
- abscesses
- post-infective strictures
What does perforation of diverticulitis look like
- ileus + peritonitis + shock
- manage like you would an acute abdomen
What is the treatment of a perforation of diverticulitis
- Hartmann’s procedure may be performed; primary anastomosis possible in some patients
- emergency laparoscopic management emerging alternative
What is the treatment of haemorrhage of diverticulitis
- embolisation or colonic resection only necessary if ongoing massive bleeding and colonoscopies haemostats has been unsuccessful
