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Large Bowel > Diverticular Disease > Flashcards

Diverticular Disease Flashcards

1
Q

What is a diverticulum

A

An out pouching of the bowel wall most commonly found in the sigmoid colon

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2
Q

What is diverticulosis

A

The presence of diverticula

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3
Q

What is diverticular disease

A

Symptomatic diverticula

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4
Q

what is diverticulitis

A

Inflammation of the diverticula

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5
Q

What is a Diverticular bleed

A

When a diverticulum erodes into a blood vessel causing large volumes of painless bleeding

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6
Q

what is the pathophysiology of diverticulosis

A

In a aging bowel, the mucosal wall become weakened over time and when the stool moves through this bowel, there is a increase in luminal pressure causing a outpouching of the weakened bowel wall.

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7
Q

How does diverticulitis occur

A

Bacteria can overgrow within the outpouchings, leading to inflammation of the diverticulum (diverticulitis) which can sometimes perforate, potentially leading to diffuse peritonitis sepsis and death.

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8
Q

What types of fistula can occur in chronic cases of diverticulitis

A

Fistula formation most commonly

Colovesical or colocovaginal

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9
Q

What two categories are diverticulitis divided into

A

Complicated and uncomplicated

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10
Q

what is complicated diverticulitis

A

Complicated diverticulitis refers to abscess presence, fistula formation, stricture, or free perforation

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11
Q

what is uncomplicated diverticulitis

A

diverticulitis describes inflammation only

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12
Q

what are the risk factors for diverticulitis

A

low dietary fibre intake, obesity (in younger patients), smoking, family history, and NSAID use.

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13
Q

How do patients present with diverticulosis

A

Aysmptomatic - most are incidentally picked up

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14
Q

What re the features of diverticular pain

A

Intermittent lower abdo pain may be colicky in nature

Altered bowel habit

Nausea

Flatulence

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15
Q

how does diverticulitis present

A

Acute abdo pain sharp in nature and normally localised to LIF

Worsened by movement

Local tenderness

Systemic upset

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16
Q

how does a perforated diverticulum present

A

signs of localised peritonism or generalised peritonitis.

17
Q

what are the complications of diverticular disease

A

Pericolic abscess

Fistula formation

Bowel obstruction

18
Q

How can we treat pericolic abscesses?

A

CT guided drainage

Laparoscopic wash out

Abx

19
Q

How can we manage bowel obstruction secondary to diverticulitis

A

Stenting/bowel resection

20
Q

what are the lab tests you would order to investigate diverticular disease

A

FBC
CRP
Faecal calprotectin
Urine dipstick

Suspected diverticulitis:
Group and save

VBG

21
Q

What imaging modalities would you use to investigate diverticular disease in someone you think has uncomplicated disease

A

Flexible sigmoidoscopy

A colonoscopy should never be performed in any presenting cases of suspected diverticulitis, due to the increased risk of perforation

22
Q

What imaging investigation would you use for someone with suspected diverticulitis

A

CT abdo/pelvis

23
Q

What is the Hinchey classification

A

A classification system used to stage the disease based on CT findings

24
Q

Outline the Hinchey classification

A

Stage 1 - pericolic/mesenteric abscess

Stage 2 - pelvic abscess

Stage 3 - purple to peritonitis

Stage 4 - faecal peritonitis

25
Q

How would you manage uncomplicated diverticular disease

A

Simple analgesia

Encourage fluid intake

26
Q

what is the conservative management of a patient with suspected/confirmed diverticulitis

A

IV Abx

IV Fluids

Bowel rest

Analgesia

( some can be managed as outpatients )

27
Q

how can you treat diverticular bleeds

A

Embolisation / surgical resection

If there is significant bleeding they will need fluid resus

Sx will improve within a couple of days
But repeat imaging is required.

28
Q

When is surgical intervention indicated

A

Only required in those with faecal peritonitis/ overwhelming sepsis

29
Q

what is the surgical procedure that is performed

A

Hartmanns procedure

30
Q

what are the complications of surgery

A
  • recurrence of diverticulitis

Large Bowel (7 decks)

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