Gastrointestinal System >
Diverticular Disease
“An umbrella term describing outpouching of the colonic mucosa and underlying connective tissue through the colon wall”
- Diverticula – multiple outpouchings of the colon wall Diverticulosis – the presence of diverticula without symptoms
- Diverticulitis – inflammation of the diverticula
Risk Factors
- Modifiable:
- Obesity
- Low-Fibre diet
- Medications
- NSAIDs
- Corticosteroids
- Smoking
- Exercise
- Non-Modifiable:
- Age
- Sex (Male)
Aetiology
No known cause.
Pathophysiology
- Increased pressure in the lumen of the colon
- An outpouching forms at a weakness in the wall
Clinical Presentation
- Presents in 4 ways:
- Asymptomatic – majority of cases
- Painful diverticular disease – pain in left lower iliac fossa
- Bleeding diverticular disease – haematuria
- Diverticulitis
- Nausea
- Fever
- Tachycardia
- Diarrhoea
- Acute left iliac pain
Investigations
- Bloods:
- FBC and CRP – looking for infection
- Imaging: n/a
- Special:
- Barium enema – may reveal diverticula, strictures and associated complications)
- Colonoscopy – may reveal co-existing complications
Management
- Dietary changes – Increased fibre, increased water intake
- Treatment of exacerbation – diverticulitis (IV antibiotics, analgesia, IV fluids)
- Surgery – segmental colectomy
Complications
- Haemorrhage
- Perforation
- Abscess
- Fistula (between the colon and bladder/vagina)
- Ileus/obstruction