Diverticular Disease

02/05/2013 by admin | Gastroenterology
  1. Many elderly people have asymptomatic ‘diverticula change’ or ‘diverticulosis’
  2. Prevalence: 50% >50yo
  3. Pathophysiology: may be genetic predisposition, but best considered an acquired condition. Those with Marfan’s and Ehlers-Danlos syndrome tend to develop diverticula earlier in life.
  4. P/c: – tend to present with ‘complications’ rather than symptoms of diverticular change…
    1. o Diverticulitis: inflammation of the bowel – related to infection, resulting from impaction of faeces
    2. o Diverticular abscess: L-sided abdo pain, fever, L-sided mass, occasional rupture with generalized peritonitis
    3. o Colovesicular fistula: enzymes released by pus cells allow diverticular abscess to erode in to bladder, causing urinary tract sepsis (frequent UTI’s) with gas-forming organisms – results in characteristic symptom of ‘pneumaturia’ (=’bubbles’ in urine).
    4. o Colonic stricture: after repeated episodes of inflammation the colon may become strictured = sub-acute colonic obstruction.
    5. o Colonic bleeding: frequent presentation of diverticular disease due to eroded artery/blood vessels
  5. Ix:
    1. o Barium enema: will detect asymptomatic change
    2. o Colonoscopy: will detect asymptomatic change
    3. o Abdominal CT: demonstrate abscesses, colovesicular fistulae.
  6. Mx:
    1. o High fibre diet: may reduce complications
  7. Tx complications:
    1. o Acute diverticulitis =IV Abx, fluids, analgesia
    2. o Diverticular abscess =drainage, IV Abx, fluids, analgesia
    3. o Bleeding =usually settles with supportive tx
    4. o Surgery: reserved for complicated disease – (with serious bleeding, abscess, stricture…) 
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