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
  1. Increased pressure in the lumen of the colon
  2. An outpouching forms at a weakness in the wall
Clinical Presentation
  • Presents in 4 ways:
    1. Asymptomatic – majority of cases
    2. Painful diverticular disease – pain in left lower iliac fossa
    3. Bleeding diverticular disease – haematuria
    4. 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

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