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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
Presentation
Erratic bowel habits
Left iliac fossa pain
Fever and constipation
Severe pain and constipation due to luminal narrowing
Asymptomatic
Presentation of examination
Tachycardia
Abdominal examination
Febrile
Tenderness and guarding of the Left side
Sometimes a palpable mass can be felt in the right ilac fossa
Treatment
Smooth muscle relaxants:
MEBEVERINE
In acute diverticulitis, you need to give
CIPROFLOXACIN
and
METRONIDAZOLE
. Demand bowel rest and IV fluids/antibiotics
Well balanced high fibre diet
Sometimes we need surgical resection
Epidemiology
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
Definition
Diverticulosis:
this is when there is a presence of a diverticulum
Diverticular disease
this is when the diverticulum is symptomatic
A
diverticulum
is an outpouching of the gut wall. This usually happens at the site of entry of perforting arteries
Diverticulitis:
inflammation of the diverticulum
Risk Factors
Low fibre diet
Aged over 50
Obese
Taking NSAIDs
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
Diagnosis
FBC: leukocytes and CRP/ESr will be raised
CT colonography: BEST GOLD STANDARD. This will show colonic wall thickening and abscesses/pericolic collections
Colonscopy
AXR: looks at the identification of free air
Barium enema
Complications
FIstula formation between the bladder or vagina
Perforation --> peritonitis happens
Intestional obstruction
Bleeding
Mucosal inflammation
Meckel's Diverticulum
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.