Diverticular Disease

Diverticular Disease

Javier E. Correa Román, MS4

Introduction

Definition of diverticulosis vs diverticulitis

Epidemiology

Risk Factors

Complication

Treatment

Multiple Choice

A 72 year old female patient presents with severe abdominal pain, nasuea and vomiting. She has a history of diverticulosis. What initial assessment finding would be most indicative for diverticulitis?

• Right Upper Quadrant tenderness

• Left Lower Quadranr tenderness

• Generalized abdominal distension

• Rebound tenderness

Multiple Choice

A 65 year-old patient presents with left lower abdominal pain, fever and changes in bowel habits. You are suspecting Diverticulitis. Which is the pathological process best explains the development of Diverticulitis in this patient?

• Increase colonic pressure leading to mucosal outpouching

• Erosion of the diverticular wall by food particles

• Hypersecretion of mucous in the colon

• Ischemia of the bowel wall

Multiple Choice

A 58 year old male patient presents with acute left lower quadrant pain and fever. His past medical history includes Diverticulosis. What would be next step?

• Abdominal Ct scan

• Abdominal/ pelvic XRAY

• Exploratory Laparoscopy

• Colonoscopy

Diverticular disease

Is an umbrella term encompassing range of conditions associated with sac-like protruding from a tubular structure (diverticulum (single) of 0.5 -1cm and diverticula (plural)). Present commonly in the sigmoid colon. The rectum is not involved due to a longitudinal muscle layer that adds extra support

Formately divided into:

  •Diverticulosis

  •Diverticulitis

Diverticulosis

Is the presence of multiple abnormal sac-like protrusions or Outpouching (diverticula) develop along the gastrointestinal tract. This sac-like protrusions or outpouching are composed of mucosa  and submucosa (false diverticulum)

-Pathophysiology
Increase in Intraluminal
Pressure
Weakness in Intestinal wall.
-Clinical Presentation
Asymptomatic or
with complications

Diverticulitis

Inflammation/infection of diverticula

-Pathophysiology
•Obstruction
•Bacterial colonization

-Clinical Presentation
•Left Lower Quadrant pain
•Fever
•Increase WBC
•Bowel habits change

Epidemiology

Prevalence

Age

Geographic Variation

Risk Factors

•Increase intraluminar pressure

Low fiber

Obesity & Sedentary lifestyle

•Smoking

•Genetic factors

•Age (<20% at age 40 & >60% by age 60)

•NSAIDS

Multiple Choice

A 65 year old female patient with known Diverticulitis presents with signs of Peritonitis. What will be the next best step?

• Administer Antibiotics

• Insert Nasogastric Tube

• Prepare the patient for Emergency Surgery tube

• Bowel rest

Multiple Choice

A patient with a history of Diverticulosis presents with acute abdominal pain and fever of 101F. The CT Scan reveals an abscess. What is the most appropriate initial treatment?

• Surgical resection of the affected area

• Intravenous Antibiotics and possible Percutaneous Drainage

• Oral Antibiotics and a high-fiber diet

• Laparoscopic Appendectomy

Multiple Choice

What Diagnostic tool is least likely to be use in the acute setting for a patient with suspected Diverticulitis?

• Abdominal CT Scan

• Abdominal Xray

• MRI

• Colonoscopy

Complications

​

• Lower Gastrointestinal Bleed

Diverticulosis

Complications

Diverticulitis

•Abscess (pus collection in diverticula)

•Fistula

•Perforation

Diagnosis and Differential Diagnosis

​Differential Diagnosis

•Appendicitis (especially with right-sided pain)

•Colorectal cancer

•Ischemic colitis

•Irritable bowel syndrome

•Inflammatory bowel disease

Multiple Choice

A 60 year old female patient presents with acute left lower quadrant pain and fever. You suspect a diagnosis of Diverticulitis. You order an Abdominal CT Scan. Which finding on abdominal CT Scan would confirm Diverticulitis?

• Thickened bowel wall with pericolic fat stranding

• Presence of Colonic Polyps

• Hepatomegaly

• Enlarged mesenteric lymph nodes

Multiple Choice

A 63 year old patient is recently diagnosed with Diverticulosis. Which teaching point is essential for a patient with a history of diverticulitis to prevent future episodes?

• Avoid all nuts

• Increase fiber intake gradually

• Consume low –fiber diet permanently

• Avoid Physical Exercise

Treatment

Diverticulosis

Acute Diverticulosis
•Improved diet - increase fiber

Complicated Diverticulosis

•Colonoscopy (Not in acute phases)

Treatment

Diverticulitis

Acute Diverticulitis

•Antibiotic

Complicated Diverticulitis

•Perforation

•Abscess

•Fistula

Follow Up

•Possible Colectomy

References

•https://pmc.ncbi.nlm.nih.gov/articles/PMC3174080/
• https://www.sciencedirect.com/science/article/pii/S2352345X19300955
• https://my.clevelandclinic.org/health/diseases/24883-diverticulosis
• https://my.clevelandclinic.org/health/diseases/10352-diverticulitis

• Uptodate