Diverticular disease
- Outpouching of the gut wall
- Diverticulitis refers to inflammation of a diverticulum
- Most occur in the sigmoid colon
- Lack of dietary fibre is thought to lead to high intraluminal pressures which force the mucosa to herniated though the muscle layers of the gut at weak points adjacent to penetrating vessels
Investigations
- PR
- Simoidoscopy
- Barium enema
- Colonoscopy
- CT
Complications
- Altered bowel habit and left sided colic relieved by defecation, nausea and flatulence
- High fibre diet may be tried
- Antispasmotics may help
- Surgical resection is occasionally resorted to
- Diverticulitis
- Perforation
- Haemorrhage
- Fistulae
- Abscesses
- Post infective strictures
Management
- Mild attacks can be managed at home with bowel rest (fluids only) and antibiotics - co-amoxiclav, metronidazole or ciprofloxacin
- If fluids cant be tolerated admit, give analgesia, IV fluids and antibiotics - cefuroxime plus metronidazole. Keep patient NBM
- Consider ultrasound to detect perforation, free fluid and collections
- If you have to do a barium enema then make sure you use water soluble contrast
- In an acute attack don’t do colonoscopy
Acute management of rectal bleeding
- ABC - resuscitation if necessary
- History and examination
- Bloods - FBC, U&Es, clotting, amylase, CRP, group and save
- Imaging - AXR plus CXR
- Fluid management - insert 2 large bore cannulae - give crystalloids. Insert a urinary catheter
- Antibiotics - may be required if there is evidence of sepsis or perforation e.g. cefuroxime plus metronidazole
- PPI - consider omeprazole
- Keep patient bed bound
- Start on stool chart
- Keep patient on clear fluids
- Surgery - for unremitting, massive bleeding