Acute Diverticulitis
Pathophysiology
Investigations
Differential Diagnoses
When to refer/seek help
Common pitfalls
Initial management
Likely presentation
Garden,J, Parks, R. 2018. Principles and practice of Surgery, 7th edition. pp. 232 - 269 Elsevier
Cook et al 2017, Diverticulitis Case study available from https://www.onhealth.com/content/1/diverticulitis_diverticulosis
nausea + vomiting
Altered Bowel Habit
Pyrexia -
Pain and tenderness LIF
CXR / AXR to look for signs of perforation
CT vs CT contrast preferably with renal contrast - in the first instance also shows if any suggestion of malignancy, abscess or fistula
Colonoscopy / Flexible Sigmoidoscopy performed although if findings suggest inflammation this would be done at a later date to prevent the risk of perforation
IVF
Analgesia
Fasting or Clear fluids to rest the bowel
Antibiotics if found to be showing signs of Sepsis, broad spectrum such as cephalosporins or gentamicin including metronidazole should be considered
10-% of these patients go on to requiring bowel resection as a result.
A third of patients require further invention, eg. Surgery
Perforation - septic shock, dehydration, marked abdominal pain and distention
Obstruction - Strictures formed in the intestinal tract
PR Bleeding
Diverticula usually develop in the left colon although can be found in the small intestine although rare
Small pouches of mucosa are called diverticula
muscular lining of the digestive system, particularly in the colon, herniations can develop. These small pouches of mucosa are called diverticula
When these herniated areas or diverticula become inflamed it is named Diverticulitis
Patient referal to appropriate speciality for colonsopy
Refer to Colorectal Surgeon for ongoing treatment
Inpatient stay in hospital until symptoms have eased
IBD
IBS
Colitis
Crohns
Obstruction