Diverticulitis

Question 1

Define diverticulosis

Answer 1

Presence of diverticula

(outpouchings of the colonic mucosa through colon wall)

Question 2

Define diverticula

Answer 2

Aquired outpouchings of colon mucosa and overlying connective tissue through the colonic wall

Question 3

Define diverticulitis

Answer 3

Diverticular inflammation +/- symptoms & signs

Question 4

Define diverticular disease

Answer 4

Diverticula associated with symptoms

Question 5

Draw a diverticula and a fistula

Answer 5

Question 6

What are the risk factors?

Answer 6

• 50+ years
• Obesity
• Smoking, NSAIDs, low-fibre diets

Question 7

What are the symptoms of diverticular disease?

Answer 7

If symptomatic;

• Intermittent LIF pain due to diverticular disease (IBD commonly co-exists)
• Constipation, bloating & rectal bleed (blood vessels are around diverticuli)

Question 8

What are the symptoms of acute diverticulitis?

Answer 8

• Rapid onset **LIF pain **& tenderness
• Bowel habit change
• Rectal bleeding
• Fever & tachycardia
• Neutrophil infiltration in colonic wall

Question 9

What are potential complications?

Answer 9

• Mass/ abcess
  
  • Persistent infection leading to mass
• Peritonitis
  
  • Perforation of abscess/ diverticula
• Fistula
  
  • Into vagina/ bladder
• Stricture
  
  • Chronic/ repetitive episodes causing fibrosis & colon narrowing

Question 10

What are the investigations?

Answer 10

CT Abdo

Question 11

What is the non-surgical treatment of diverticulitis?

Answer 11

• High fibre diet, high fluid intake, stool softeners (lowers intracolonic pressure)
• IV antibiotics
• Significant paracolic abscess drainage

Question 12

What is the surgical treatment of diverticulitis?

Answer 12

• Resection for;
  
  • Acute inflammation failing to respond to meds
  • Undrained paracolic sepsis
  • Perforation