Diverticular disease

What is diverticulosis?

Presence of diverticula

What is diverticulitis?

Inflammation of the diverticula

What are the main risk factors for diverticular disease? (6)

1. Age 2. Low dietary fibre intake 3. Obesity 4. Smoking 5. Family history 6. NSAID use

What are some other symptoms of diverticular disease? (3)

1. Altered bowel habit 2. Associated nausea 3. Flatulence

What are the two more common fistula types in diverticulitis?

1. Colovesical 2. Colovaginal

What are the four manifestations of diverticular disease?

1. Diverticulosis 2. Diverticular disease 3. Diverticulitis 4. Diverticular bleed

What are the two other differentials for patients presenting with lower abdominal pain and bowel symptoms?

1. IBD 2. Bowel cancer

Give some features of diverticular disease? (3)

1. Intermittent lower abdominal pain 2. Typically colicky in nature 3. May be relieved by defecation

What are some other causes of abdominal pain? (3)

1. Mesenteric ischaemia 2. Gynaecological causes 3. Renal stones

What proportion of >50 and >80 year olds have diverticulosis?

50% in over 50 and 70% in over 80

What does complicated diverticulitis refer to?

Abscess presence or free perforation

How will acute diverticulitis usually present?

Acute abdominal pain - sharp in nature and normally localised in the left iliac fossa - worsened by movement

What is a diverticulum?

An outpouching of the bowel wall

How is a diverticular abscess otherwise referred to?

As a pericolic abscess

What is the pathophysiology of diverticulitis?

Bacteria can overgrow within the pouchings, leading to inflammation of the diverticulum which can sometimes perforate

What is the consequence of diverticulitis perforation?

Diffuse peritonitis with sepsis and death

What can occur in chronic cases of diverticulitis?

Fistulae can form

What is the pathophysiology of diverticulosis formation?

In an ageing bowel that has naturally become weakened over time the movement of stool within the lumen will cause an increase in luminal pressure. This results in an outpouching of the mucosa through the weaker areas of the bowel wall (at the junctions of the triangular muscle sheets and blood vessels penetrate to supply the bowel wall)

What proportion of those with diverticulosis are symptomatic?

Only around 25%

What is first line for larger diverticular abscesses?

Radiological drainage

Where are diverticuli most commonly found?

Sigmoid colon

What are the two main classifications of diverticulitis?

Simple or complicated

What is required for multi-loculated abscesses or patients who clinically deteriorate?

Surgical intervention either with a laparoscopic washout or hartmann's procedure

What is diverticular disease?

Symptoms arising from the diverticula

What diverticular abscesses can be managed with IV antibiotics?

Those that are <5cm.

What is a diverticular bleed?

Where the diverticulum erodes into a vessel and causes a large volume painless bleed

How will a perforated diverticulum present?

With signs of localised peritonism or generalised peritonitis

What will acute diverticulitis be like on examination?

Localised tenderness alongside features of systemic upset, such as decreased appetite, pyrexia or nausea