Diverticular disease Flashcards
Diverticulum definition
out-pouching of tubular structure
True diverticulum
composed of complete wall (e.g. Merkel’s)
False diverticulum
composed of mucosa only (pharyngeal, colonic)
Epidemiology of diverticulosis (prevalence, sex ratio)
30% of Westerner’s have diverticulosis by 60 years old
F>M
pathophysiology of diverticulosis
Assoc. with ↑ intraluminal pressure (Low fibre diet: no osmotic effect to keep stool wet)
Mucosa herniates through muscularis propria at points of weakness where perforating arteries enter.
most common site for diverticulosis
sigmoid colon
Saint’s triad?
hiatus hernia
cholelithiasis
diverticular disease(commoner in obese pts.)
symptoms of diverticular disease
Altered bowel habit ± left-sided colic (Relieved by defecation)
Nausea
Flatulence
treatment of diverticular disease
high fibre diet,
mebeverine may help
elective resection for chronic pain
diverticulitis
Inspissated faeces → obstruction of diverticulum → inflammation
(Elderly pt. with prev Hx of constipation)
presentation of diverticulitis
abdo pain & tenderness (typically LIF, localised peritonitis)
pyrexia
blood tests for diverticulitis
FBC: ↑WCC↑CRP/ESR
Amylase
G+S/x-match
Imaging for diverticulitis
Erect CXR: look for perforation
AXR: fluid level / air in bowel wall
Contrast CT : Gastrograffin enema
Endoscopy for diverticulitis
flexi sigmoidoscopy
Colonoscopy (not in acute attack)
Hinchey grading
- Small confined pericolic abscesses Surgery rarelyneeded
- Large abscess extending into pelvis (May resolve w/osurgery)
- Generalised purulent peritonitis (Surgery needed)
- Generalised faecal peritonitis (Surgery needed)
