Diverticular Disease Flashcards
What is diverticular disease (diverticulosis)?
A clinical condition resulting from the presence diverticular (outpouchings of mucosa and submucosa, typically affecting the sigmoid colon)
Classic presentation of diverticular disease?
Constipation or diarrhoea w/ left lower abdominal pain.
Possible PR bleed.
Signs on exam (diverticular disease)?
Tender @ left lower quadrant/on digital rectal exam
What is diverticulitis?
Inflammation of diverticula
Who does diverticulitis typically present in?
> 50s + consume western diet (low fibre)
Presentation of diverticulitis?
- Left lower quadrant pain
- Fever
- N&V
Examination signs of diverticulitis? Sign if perforation or generalised peritonitis?
- Pyrexia
- Left lower qaudrant tender/guarding
- diffuse tenderness = perforation/peritonitis
Variable term complications of diverticulitis?
1) Abscess formation
2) Perforation
Management of abscess in diverticulitis?
Conservative
- -> bowel rest
- -> broad spec antibiotics
- -> +/- CT-guided percutanous drainage
Surgical - if conservative fails
Management of Perforation in diverticulitis?
Abdo X-Ray –> free air
Surgical repair
Long-term complications of diverticulitis?
- fistula formation
- colovesical fistula (most common)
- -> pneumaturia (gas in urine)
- -> faecaluria (faeces in urine)
- -> recurrent UTIs
- strictures, large bowel obstruction
Diagnosis and repair of colovesical fistula?
Ix - Abdo CT
Quesmed - cystoscopy to diangose?
Management of asymptomatic diverticulosis?
No treatment
Management of symptomatic diverticulosis?
- increase fibre + hydrate
- analgesia
Management if evidence of inflammation (leukocytosis, fever)?
oral abx (7 days co-amoxiclav)
IV abx (ceftriaxone + metronidazole) if no improvement after 72 hrs
