diverticulitis

Question 1

what is diverticulosis and what age does it affect

Answer 1

• 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

Question 2

what is diverticular disease

Answer 2

• 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

Question 3

what is acute diverticulitis

Answer 3

• diverticula suddenly become inflamed or infected

Question 4

signs and symptoms of acute diverticulitis

Answer 4

• 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

Question 5

what is complicated acute diverticulitis

Answer 5

• diverticula become inflamed or infected
• and associated with complications e.g. abscess, bowel perforation, peritonitis, fistula, intestinal obstruction, haemorrhage, sepsis

Question 6

non drug treatment

Answer 6

• 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

Question 7

what to remind pt with diverticular disease about fibre

Answer 7

• may take several weeks for the benefits of increasing fibre in diet to be achieves
• if high fibre diet tolerated, continue for life

Question 8

management of complicated acute diverticulitis

Answer 8

emergency or elective surgery management may be required

Question 9

drug treatment in diverticulosis

Answer 9

• asymptomatic so specific treatments not recommended
• consider bulk forming laxatives in pt with constipation

Question 10

drug treatment in diverticula disease

Answer 10

• 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

Question 11

Use of NSAIDs and opioid analgesics in diverticular disease

Answer 11

do not use NSAIDs and opioid - can increase risk of diverticular perforation

Question 12

drug treatment acute diverticulitis

Answer 12

• 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

Question 13

aminosalicylates or prophylactic abx to prevent recurrent acute diverticulitis

Answer 13

NOT recommended

Question 14

suspected complicated acute diverticulitis and uncontrolled abdominal pain

Answer 14

refer of same day hospital assessment

Question 15

significant rectal bleeding

Answer 15

urgent referral to hospital

Question 16

in which patients would you offer an abx prescribing strategy ? (acute diverticulitis)

Answer 16

• systemically unwell
• immunosuppressed
• significant comorbidities
• systemically unwell and do not meet referral criteria for suspected complicated acute diverticulitis

Question 17

pt unable to take oral abx when it is indicated for uncomplicated acute diverticulitis

Answer 17

refer to hospital

Question 18

suspected or confirmed uncomplicated acute diverticulitis, 1st line

Answer 18

co-amox 625mg TDS for 5 days, then review

WAY TO REMEMBER: DIVERTICULITIS (CULITIS - SEVERE CELLULITIS) = COAMOX

Question 19

alternatives for suspected or confirmed uncomplicated acute diverticulitis if penicillin allergy or co-amox not suitable

Answer 19

• cefalexin (caution penicillin allergy) + metro
• trimethoprim + metro
• ciproflox (if switching from IV route with specialist advice) + metro

Question 20

1st line abx regimens for suspected or confirmed complicated acute diverticulitis

Answer 20

IV!
- co amox
- cefuroxime + metro
- amox + gentamicin + metro

Question 21

abx regimens for suspected or confirmed complicated acute diverticulitis if penicillin and cephalosporin allergy

Answer 21

ciproflox + metro