General surgery - diverticular disease

Question 1

What is diverticular disease?

Answer 1

Diverticulosis - presence of outpouchings from the bowel wall

Diverticulosis may be referred to as diverticular disease when patients experience symptoms.

Diverticulitis - inflammation of diverticula

Question 2

Pathophysiology of diverticular disease

Answer 2

Increased pressure in the lumen overtime can cause gaps to form in weak areas of muscle in the bowel wall

These gaps allows the mucosa to herniate through

Question 3

Presentation of diverticular disease and management of it

Answer 3

LIF pain
Constipation
Rectal bleeding

Management

• increase fibre in the diet
• Bulk forming laxatives e.g. isphagala husk
• Avoid stimulant laxatives
• Surgery in severe symptoms

Question 4

Acute diverticulitis presentation

Answer 4

LIF pain
Fever
Diarrhoea
N+V
Rectal bleeding

Palpable abdominal mass (if an abscess has formed)

Raised inflammatory markers

Question 5

Management of acute diverticulitis

Answer 5

Primary care:

• Oral Co-amoxiclav 500/125 TDS for 5 days (pen allergic can use Cefalexin plus metronidazole or trimethoprim)
• Clear fluids until symptoms improve (2-3d)
• Analgesia
• Follow up in 2 days

Secondary care

• Admit to hospital if severe pain, complications
• NBM/ clear fluids only
• IV Abx as per guidelines
• IV fluids
• Analgesia
• CT scan
• Urgent surgery for any complication

Question 6

Complications of acute diverticulitis

Answer 6

Perforation
Peritonitis
Peridiverticular abscess
Large haemorrhage (needed blood transfusions
Fistula - e.g. between the colon and bladder/vagina
Ileus/obstruction