Diverticular Disease Flashcards
what is the typical presentation for diverticular disease?
acute LIF (colichy -> constant), Pain, bloody stool, fever, raised WCC, urinary symp
what is meant by diverticulosis?
presence of diverticulae outpouching of the colonic mucosa and submucosa through the muscular wall of the large bowel
what is meant by diverticular disease?
diverticulosis associated with complications-> Haemorrhage, infection, fistulae
what is meant by diverticulitis?
acute inflammation and infection of the diverticulae
outline the aetiology of diverticular disease?
low fibre diet leads to lots of stool bulk
- > leads to generation of high colonic intraluminal pressure to propel stool out
- > leads to herniation of mucosa and submucosa through muscle layers of gut at weak points adjacent to penetrating vessels
what are the risk factors for diverticular disease?
low fibre diet
more than 50 years old
outline the pathogenesis of diverticulitis?
Diverticulae are most commonly found in the sigmoid and descending colon
However, they can also be right-sided
Diverticulae are NOT found in the rectum
Diverticulae are found particularly at sites of nutrient artery penetration
Diverticular obstruction by thickened faeces can lead to bacterial overgrowth, toxin production and mucosal injury
Which can then lead to diverticulitis, perforation, pericolic phlegmon, abscess, ulceration and fistulation or stricture formation
Summarise the epidemiology of diverticulae disease?
Diverticular disease is VERY COMMON. 60% of people living in industrialised countries will develop colonic diverticulae
Rare < 40 yrs. Right-sided diverticulae are more common in Asia
Perforated diverticulitis is common in Western societies
what are the presenting symptoms of diverticular disease?
Often ASYMPTOMATIC (80-90%)
Complications can lead to symptoms such as:
PR bleeding
- Blood supply to colon is where outpouches occur so bleeds a lot
- NSAIDs are known to provoke bleeding
Diverticulitis -causing LIF and lower abdominal pain and fever
Diverticular fistulation-causing pneumaturia, faecaluria and recurrent UTI
what are the signs of diverticulitis on physical examination?
general pain
left iliac fossa pain on palpation
staying still ( peritonitis)
what are the appropriate investigations for diverticular disease?
Bloods:
- FBC: increased WCC, increased CRP
- Check clotting and cross-match if bleeding
Barium Enema (with or without air contrast):
- Shows presence of diverticulae (saw-tooth appearance of lumen)
- This reflects pseudohypertrohy of circular muscle
- IMPORTANT: barium enema should NOT be performed in the acute setting because there is a high risk of perforation
Flexible Sigmoidoscopy and Colonoscopy:
- Diverticulae can be visualised and other pathology (e.g. polyps and tumours) can be excluded
- This also risks perforation in acute setting
In ACUTE setting: CT scan for evidence of diverticular disease and complications may be performed
what are the possible complications of diverticular disease?
Diverticulitis
Pericolic abscess
Perforation
Faecal peritonitis – faeces in peritoneal cavity
Colonic obstruction
Fistula formation (bladder, small intestine, vagina)
Haemorrhage
Post infective strictures
Abscesses
summarise the prognosis of diverticular disease?
10-25% have one or more episodes of diverticulitis
what is the management for chronicasymptomatic diverticular disease?
Soluble high-fibre diet (20-30 g/day)
Some drugs are under investigation for their use in preventing recurrent flares of diverticulitis (probiotics and anti-inflammatories e.g. mesalazine)
what is the management for acute diverticulitis?
IV antibiotics
IV fluid rehydration
Bowel rest
Abscesses may be drained by radiologically sited drains
what is the Hartman’s procedure?
Removal of the diseased bowel and an end-colostomy formation with a an anorectal stump
This is used when a primary anastomosis (immediate joining) is not possible (e.g. inflammation)
