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Flashcards in GI Disease Deck (12):
1

What are the 2 classifications of diverticula?

True “congenital” diverticulum or acquired “false” “pseudo” diverticulum

2

What are the 3 main types of diverticula seen in clinical practice?

Sigmoid diverticulosis ( acquired diverticula )
Diverticulosis of the right colon ( acquired and congenital diverticula )
Giant diverticulum

3

What is diverticulosis of the colon?

Protrusions of mucosa and submucosa through the bowel wall

Commonly sigmoid colon

Located between mesenteric and anti-mesenteric taenia coli ( also between anti-mesenteric t.coli in 50 % cases )

Less commonly extend into proximal colon
eg. Caecum ( 15 % )

4

What is the epidemiology behind diverticula?

Common in developed (western) world
Rare in Africa , Asia , S. America
Common in urban cf. rural areas

Changing prevalence in migrant populations

Relationship with fibre content of diet

Male = Female

Less common in vegetarians

Prevalence increases with age

5

What is the pathogenesis of diverticula?

Increased intra-luminal pressure
- Irregular , uncoordinated peristalsis
- Overlapping ( valve like ) semicircular arcs of bowel wall

Points of relative weakness in the bowel wall
- Penetration by nutrient arteries between mesenteric and antimesenteric taenia coli
- Age related changes in connective tissue

6

What is the pathology of diverticulosis?

Thickening of muscular propria-(earliest change – “prediverticular disease”)

Elastosis of taeniae coli (leading to shortening of colon)

Redundant mucosal folds and ridges

Sacculation and diverticula

7

What are the clinical features of diverticular disease?

Asymptomatic ( 90 – 99 % )

Cramping abdominal pain

Alternating constipation and diarrhoea

Acute and chronic complications ( 10 – 30 % )

8

What are the acute complications of diverticular disease?

Diverticulitis / peridiverticular abscess ( 20 – 25 % )
Perforation
Haemorrhage ( 5 % )

9

What are the chronic complications of diverticular disease?

Intestinal obstruction (strictures : 5 – 10%)
Fistula (urinary bladder, vagina)
Diverticular colitis (segmental and granulomatous)
Polypoid prolapsing mucosal folds

10

What is colitis?

“inflammation of the colon”

usually mucosal inflammation but occasionally transmural ( eg. crohns disease ) or predominantly submucosal/muscular ( eg. eosinophilic colitis )

divided into acute (days to a few weeks) and chronic (months to years)

11

What are the different types of acute colitis?

Acute infective colitis eg. campylobacter, salmonella, CMV
Antibiotic associated colitis ( including PMC )
Drug induced colitis
Acute ischaemic colitis ( transient or gangrenous )
Acute radiation colitis
Neutropenic colitis
Phlegmonous colitis

12

What are the different types of chronic colitis?

Chronic idiopathic inflammatory bowel disease
Microscopic colitis (collagenous & lymphocytic)
Ischaemic colitis
Diverticular colitis
Chronic infective colitis eg. amoebic colitis & TB
Diversion colitis
Eosinophilic colitis
Chronic radiation colitis