diverticular disease 
definition
medical: disease with diverticular outpouchings, including a wide range of sx severity
colonic diverticulosis = herniation of mucosa and submucosa through mucosal layer
diverticulitis = inflammation of a diverticulum
layman: Lots of people have small pouches of tissue that bulge outwards from their gut wall. Doctors call these pouches diverticula. If you get symptoms because of these pouches, your doctor may say you have diverticular disease. If these pouches become inflamed or infected, this is called diverticulitis. Sometimes diverticulitis can lead to more serious problems, such as a hole in your bowel or a blockage that stops you passing stools.
aetiology
pathology
alteration in colonic wall structure
collagen
elastin
abnormal motility
connective tissue disfunction
classification
hinchey
epidemiology
rfx
tobacco
etoh
caffeine
steroid
nsaid
protective
vegetarianism
with age
fever
leukocytosis
bmi
dietary fibre
dx
hx
left lower quadrant abdo pain
fever
bloating
constipation
rarely rectal bleeding
ex & ix
beside
lab
imaging
fever
leukocytosis
abdo exam
left lower quadrant guarding and tenderness
pelvic tenderness on dre
fbc
u&e
crp
contrast and noncontrast abdo ct
abdo uss
mri
cxr
colonoscopy/sigmoidoscopy
ct angiogram
also
diagnostic laparoscopy
rx
conservative
medical
surgical
if acute diverticulitis suspected
calculate news
think sepsis
surg consult
bleeding management
advise healthy diet
exercise
give lf advice even in asymptomatic
sx diverticulosis
bulk forming laxatives
antispasmodic (dicycloverine)
paracetamol
stop nsaid and opioid
acute diverticulitis
abx if needed (amoxiclave)
ct angio
colonoscopy to stop bleedinga
abscess drainage
laparoscopic washout for bowel perforation
resection for faecal peritonitis
emergency hemicolectomy for diffuse peritonitis
hartmanns
primary anastomosis
complications
monitor with flexible sigmoid/colonscopy after the first episode to rule out colorectal cancer or ddx (after 6-8/56)
fistula
colorectal neoplasm
abscess
perforation
stricture
obstruction
prognosis
most people recover with medical rx
1/3 get recurrent disease esp if young
post surg sx remain in 1/4