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Diverticulitis (Epidemiology (Diverticulum can be acquired or congenital…
Diverticulitis
Epidemiology
Diverticulum can be acquired or congenital and may occur elsewhere but the most important are ACQUIRED COLONIC DIVERTICULA
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They are most frequent in the SIGMOID COLON, but can be present throughout the whole colon
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Complications
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Fistula formation
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The bladder resulting in dysuria (pain when urinating) or pneumaturia 9gas or air in urine resulting in bubbles)
Mucosal inflammation
Occurs in areas of diverticula, giving the appearance go Crohn's on endoscopy
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Key Facts
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A GI diverticulum is an out pouching of the gut wall, usually at sites of entry of perforating arteries
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Pathophysiology
Diverticula formation
In a low fibre diet, the colon mush push harder to move things along (fibre helps gut motility) so pressure increases
The pressure increase results in pouches of mucosa being extruded through the muscular wall through weakened areas near blood vessels leading to diverticula formation
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Acute diverticulitis
Occurs when faeces obstruct the neck of the diverticulum, causing stagnation and allowing bacteria to multiply and produce inflammation
This can then lead to bowel perforation (peridiverticulitis), abscess formation, fistulae into adjacent organs, haemorrhage and generalised acute peritonitis and possibly death
Clinical Presentation
Diverticular disease
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Asymptomatic in 95% of cases and is usually detected incidentally on colonoscopy or barium enema examination
Acute diverticulitis
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On examination
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Abdominal examination
Tenderness, guarding and rigidity on the LEFT SIDE of abdomen
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Treatment
Diverticular disease
In uncomplicated symptomatic disease recommend a well-balanced HIGH FIBRE DIET with smooth muscle relaxants i.e. antispasmodics
Acute diverticulitis
Those with signs of systemic upset (fevers, tachycardia) and significant abdominal pain require bowel rest, IV fluids & antibiotics
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