Diverticular Disease

Question 1

what is a diverticulum

Answer 1

outpouching of gut wall

Question 2

what is diverticulosis

Answer 2

presence of diverticula

Question 3

what is diverticular disease

Answer 3

symptomatic

Question 4

what is diverticulitis

Answer 4

inflammatory

Question 5

where does most of it occur

Answer 5

sigmoid colon

Question 6

what is the pathology

Answer 6

lack of dietary fibre, increase in intraluminal pressures- force mucosa to herniate through muscle layers at weak points

Question 7

investigations

Answer 7

colonoscopy, barium enema.

Question 8

what investigations should not be done in the acute setting

Answer 8

colonoscopy or barium enema as risk perforation. do CT abdomen

Question 9

features diverticulosis

Answer 9

altered bowel habit +- left sided colic relieved by defacation, nausea and flatulence.

Question 10

treatment diverticulosis

Answer 10

diet- high fibre. anti spasmodics- eg mebeverine

Question 11

features diverticulitis

Answer 11

pyrexia, incr WCC, incr CRP/ESR, tender colon +- localised or generalised peritonism

Question 12

treatment diverticulitis

Answer 12

analgesia, NBM, IV fluids, antibiotics, CT guided drainage

Question 13

complications diverticulitis

Answer 13

perforation, haemorrhage, fistulae, abscess, post infective strictures

Question 14

presentation perforation

Answer 14

ileus, peritonitis +- shock

Question 15

features haemorrhage

Answer 15

sudden and painless. rectal bleeding. embolise or colonic resection

Question 16

features abscesses

Answer 16

swinging fever, leucocytosis, localising signs

Question 17

managing diverticulitis

Answer 17

mild attacks- stay at home- bowel rest (fluids only) +- Abx. if fluids cant be tolerated or pain un controlled admit. analgesia, NBM, IV fluids. imaging- erect CXR and USS to detect perf, free fluid.