diverticulitis Flashcards
what is diverticulosis and what age does it affect
- asymptomatic condition characterised by presence of diverticula
- diverticular are small pouches that protrude from the walls of the large intestine
- age related - most pt 40 and over
what is diverticular disease
- diverticula are present with symptoms e.g. abdominal tenderness and/or mild, intermittent abdominal pain with constipation, diarrhoea or occasional large rectal bleeds
- symptoms may overlap with other conditions e.g. colitis, IBS, malignancy
what is acute diverticulitis
- diverticula suddenly become inflamed or infected
signs and symptoms of acute diverticulitis
- contains lower abdominal pain, usually severe, together with features such as
- fever
- sudden change in bowel habit
- significant rectal bleeding
- lower abdominal tenderness
- palpable abdominal mass
what is complicated acute diverticulitis
- diverticula become inflamed or infected
- and associated with complications e.g. abscess, bowel perforation, peritonitis, fistula, intestinal obstruction, haemorrhage, sepsis
non drug treatment
- healthy, balanced diet and increase fibre
- if constipation and on low fibre diet, gradually increase fibre to minimise flatulence and bloating
- also ensure good fluid levels esp if dehydration is a risk
- exercise
- weight loss
- smoking cessation
what to remind pt with diverticular disease about fibre
- may take several weeks for the benefits of increasing fibre in diet to be achieves
- if high fibre diet tolerated, continue for life
management of complicated acute diverticulitis
emergency or elective surgery management may be required
drug treatment in diverticulosis
- asymptomatic so specific treatments not recommended
- consider bulk forming laxatives in pt with constipation
drug treatment in diverticula disease
- abx not recommended
- consider bulk forming laxative if pt has persistent constipation or diarrhoea, or if high fibre diet unsuitable
- simple analgesia in pt with ongoing abdominal pain
- antispasmodics in abdominal cramps
- do not use NSAIDs and opioid - can increase risk of diverticular perforation
- consider alternative diagnosis in pt with persistent symptoms or symptoms that do not respond to treatment
Use of NSAIDs and opioid analgesics in diverticular disease
do not use NSAIDs and opioid - can increase risk of diverticular perforation
drug treatment acute diverticulitis
- simple analgesics e.g. paracetamol if systemically well
- consider watchful waiting and a new abx prescribing strategy and advice pt to represent if symptoms worsen
- if persistent or worsening symptoms, reassess in primary care and consider referral to hospital for further assessment
aminosalicylates or prophylactic abx to prevent recurrent acute diverticulitis
NOT recommended
suspected complicated acute diverticulitis and uncontrolled abdominal pain
refer of same day hospital assessment
significant rectal bleeding
urgent referral to hospital
