Diverticular disease NOTE: can be confused with appendicitis but all of…
Diverticular disease NOTE: can be confused with appendicitis but all of the symptoms are on the LHS
Erratic bowel habits
Left iliac fossa pain
Fever and constipation
Severe pain and constipation due to luminal narrowing
Presentation of examination
Tenderness and guarding of the Left side
Sometimes a palpable mass can be felt in the right ilac fossa
Smooth muscle relaxants:
In acute diverticulitis, you need to give
. Demand bowel rest and IV fluids/antibiotics
Well balanced high fibre diet
Sometimes we need surgical resection
Happens most frequently in the sigmoid colon
Common condition affecting 50% of patients aged 50 or over
Can have congenital and acquired problems
Causes: include, obesity, smoking, NSAIDs and a low fibre diet
this is when there is a presence of a diverticulum
this is when the diverticulum is symptomatic
is an outpouching of the gut wall. This usually happens at the site of entry of perforting arteries
inflammation of the diverticulum
Low fibre diet
Aged over 50
Pathophysiology. So how does one form?
Pressure increases in this system and means that we mucosa is pushed through the muscular walls at these sites and thus means that there will be diverticular formation
This thickens the muscle layer
The diverticular forms at junctions where blood vessels penetrate. This means that in a low fibre diet the colon must push harder to move things along
SO WHAT IS ACUTE DIVERTICULITIS?
This happens when there is a build up of faeces in one of the diverticular meaning that there is a build upof bacteria. That multiple and produce inflammation.
This can lead to bowel perforation, abscess formation, fistulae and haemorrhage. Alongside generalised acute peritonitis. All problems that can lead to death
FBC: leukocytes and CRP/ESr will be raised
CT colonography: BEST GOLD STANDARD. This will show colonic wall thickening and abscesses/pericolic collections
AXR: looks at the identification of free air
FIstula formation between the bladder or vagina
Perforation --> peritonitis happens
Symptomless and occurs in the walls of the ileum
Caused by an incomplete obliteration of the vitelline duct.
95% the diverticulum is made from intestinal mucosa. However, sometimes it is made from the pancreatic or gastric mucosa. This means that they have enzymatic processes that can digest the contents of the intestine, Leading to ulceration and perforation.