acute diverticulitis

Question 1

most common location?

Answer 1

sigmoid colon

Question 2

mx?

Question 3

what is diverticulosis?

Answer 3

Diverticulosis is an asymptomatic condition characterised by the presence of diverticula in large intestines

Question 4

what is diverticular disease? presentation?

Answer 4

Diverticular disease is a condition where diverticula are present with symptoms such as;

abdominal tenderness and/or mild, INTERMITTENT lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds

may present like IBS

Question 5

what is acute diverticulitis?

Answer 5

Acute diverticulitis occurs when diverticula suddenly become inflamed or infected

Question 6

sx of Acute diverticulitis?

Answer 6

CONSTANT lower abdominal pain (usually severe) +

Fever,
SUDDEN change in bowel habits
SIGNIFICANT rectal bleeding,

lower abdominal tenderness, or a palpable abdominal mass.

Question 7

what is Complicated acute diverticulitis?

Answer 7

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

Question 8

Aetiology?

Answer 8

Genetic and environmental factors are described as causative,

Most commonly: a low dietary fibre intake

predisposing factors described include decreased physical activity, obesity, increased red meat consumption, tobacco smoking, excessive alcohol and caffeine intake, steroids, and non-steroidal anti-inflammatory drugs

Question 9

Mx of ACUTE diverticulitis?

Answer 9

1. Patients with diverticulosis or diverticular disease should be advised to eat a healthy, balanced diet including whole grains, fruit and vegetables.
   Increase fibre. Drink more water to avoid constipation
   - tell them: may take several weeks for the benefits of increasing fibre in their diet to be achieved and that if a high-fibre diet is tolerated, it should be continued for life.
2. Paracetamol; for ongoing abdo pain

— if systemically well that’s it. safety net; “come back if sx worsen or persist”

-> We try not to prescribe abx as may cause recurrent acute diverticulitis.
if we do it will be CO-AMOXICLAV 625mg PO

Question 10

mx of diverticular disease?

Answer 10

1. Paractemol
2. Bulk-forming laxatives
   - when a high-fibre diet is unsuitable, or for patients with persistent constipation or diarrhoea.

Question 11

which diverticulitis patients need hosp assessment?

Answer 11

Refer patients with suspected COMPLICATED acute diverticulitis and uncontrolled abdominal pain for hosp assessment

Question 12

which analgesisa cant be used?

Answer 12

NSAIDS or Opiods due to increased risk of perforation

Question 13

Mx of complicated disease?

Answer 13

Rectal bleeding:
fluid resus
blood transfusion if needed - significant rectal bleed
colonoscopy; for diagnosis and endoscopic haemostasis

Classify with Hinchley classification

later; advise high fibre diet if suitable

Perforation/ abscess/obstruction:
IV Abx, Analgesia, Surgical drainage or Explorative Laproscopy/Laparotomy
advise diet

Question 14

prognosis?

Answer 14

Most do not require surgical intervention. Get better with diet and paracetamol.

Diverticular disease recurs in one third of patients

Following surgical treatment, approximately 25% of all patients continue to remain symptomatic.

Question 15

how does meckels present?

Answer 15

usually before age 2

congenital

most commonly;
passage of bright red blood per rectum (haematochezia)
obstruction,
then; inflammation, or perforation, intractable constipation (obstipation)