Diverticular disease

• What is a diverticulum?

  Pouch or pocket in the bowel wall

  Usually range from 0.5-1 cm
• What is diverticulosis?

  Presence of asymptomatic diverticula
• What is diverticular disease?

  Symptomatic diverticula in absence of inflammation
• What is diverticulitis?

  Symptomatic acute inflammation & infection of diverticula
• What are the RFs of diverticular disease?

  Older age

  Low dietary fibre intake

  FHx

  Obesity

  Smoking
• Pathophys - diverticular disease

  Large intestine has layer of circular muscle

  Points where muscle layer is penetrated by blood vessels are areas of weakness

  Increased pressure in lumen over time -> gap in areas of circular muscle -> allows mucosa to herniate through muscle layer & pouches -> diverticula

  Faeces can become trapped in diverticula and cause diverticulosis
• Where do diverticula NOT form?

  Rectum
• Which section of the bowel is most commonly affected by diverticulosis?

  Sigmoid colon
• What are the signs & symptoms of diverticulitis?

  LIF pain/tenderness

  PR bleeding

  Fever

  Change in bowel habits

  Nausea & vomiting

  Guarding +/- peritonism (severe)

  Tachycardia

  Hypotension
• What are the Inx for diverticulitis?

  Obs

  Full Hx & examination

  Bloods (FBC, U&Es, CRP, LFTs, amylase, G&S, VBG)

  CT abdo & pelvis with contrast
• What is the management of diverticulitis?

  Abx

  IV fluids (if unwell)

  Analgesia

  Surgical review +/- surgery (severe)
• What are the possible complications of diverticulitis?

  Abscess formation

  Perforation

  Fistula formation

  Colonic stricture +/- obstruction

  Lower GI bleed
• What is the management of asymptomatic diverticulosis?

  No treatment

  Advice on high-fibre diet & weight loss
• How is symptomatic diverticulosis managed?

  Increased fibre intake

  Bulk forming laxatives (ispaghula husk)

  Avoid stimulant laxatives (senna)