What is diverticulosis
presence of diverticula (out-pouching) in an asymptomatic patient
What is diverticular disease
diverticula cause symptoms, such as intermittent lower abdominal pain, without inflammation and infection
What is diverticulitis
Inflammation of diverticulum
Causes severe lower abdominal pain, fever, general malaise, and occasionally rectal bleeding
Epidemiology of diverticula
- More common with increasing age
- Sigmoid colon affected mostly
- 30% of Westerners have diverticulosis by age 60.
RFs
- Increasing age
- Obesity
- Smoking
- NSAIDs
- Low dietary fibre
What is colonic diverticulosi
formation of outpouchings (diverticula) in the wall of the colon, most frequently affecting the sigmoid due to its small diameter (small diameter = higher pressures).
True and pseudodiverticula
True = Diverticula include all layers - mucosa to serosa
Pseudodiverticula= mucosa + submucosa
Formations of colonic diverticula
High pressure pushes walls so they bubble out and form pouches
Where do diverticula tend to form
spots where the blood vessels that supply the intestinal walls traverse the muscle layer
This spot is slightly weaker, making it more likely for diverticula to form.
What happens as diverticula form?
blood vessel responsible for wall weakness becomes separated from the intestinal lumen by mucosa > therefore subject to injury and predisposed to rupture > result in bleeding which can pass into stool
Pathophysiology of diverticular disease
High pressures in colon / weak wall ~~> diverticula ~~> if faecal matter or bacteria gather ~~> inflammation and rupture of vessels = diverticulitis
How does diverticulitis happen?
- fecal matter, or fecaliths, become lodged in the diverticula (less common)
- erosion of the diverticular wall from higher luminal pressures.
Risk factors for high pressures in colon
Constipation
Obesity
NSAID’s
Smoking
Signs of Diverticular disease + diverticulitis
- Pyrexia
- Left lower quadrant or iliac fossa tenderness and guarding
- Left iliac fossa tender mass
- Tachycardia
Symptoms of diverticular disease
- Bowel habits changed
- Bloating
- Flatulence
- Left lower quadrant pain
- N&V
Symptoms of diverticulitis
Same as diverticular disease
And FEVER AND BLOOD IN STOOL
Complications of diverticular disease
- Infection ~~ abscess
- Bowel perforation
- Peritonitis
- Haemorrhage
- Obstruction
- Fistulae into adjacent organs
What would you expect to find on examination for diverticular disease
- Tenderness and guarding
- Distended and tympanic to percussion
- Bowel sounds diminished
Investigations
FBC
U&Es
CRP and ESR
VBG
Gold standard examination for diverticular disease
Contrast CT SCAN ~~~> ultrasound MRI
Diverticulitis management
Mild: oral antibiotics, analgesia, low residue or liquid diet
Severe:
- NBM, IV fluids and analgesia
- IV antibiotics:co-amoxiclav is typical but depends on local guidelines
- surgery
- diverticular abcess
Key diagnostic factors of diverticular disease
- Left lower quadrant abdo pain
- Leukocytosis
- Fever
Complications of diverticular disease
- Fistulae
- Abcess
- Perforation
- Strictures
