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Diverticulosis

Diverticulosis. Outpouchings of intestinal wall Incidence: 10% of people >45 yrs 10% increase per decade of life. aetiology. Pressure-induced formation Weak points of colonic mucosa Penetration of arterioles into the circular muscle layer of colon Common in Sigmoid colon

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Diverticulosis

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  1. Diverticulosis • Outpouchings of intestinal wall • Incidence: 10% of people >45 yrs • 10% increase per decade of life

  2. aetiology • Pressure-induced formation • Weak points of colonic mucosa • Penetration of arterioles into the circular muscle layer of colon • Common in Sigmoid colon • Low-fibre diet causes low stool bulk thereby increase intra-colonic pressure which forces the mucosa through the muscle wall alongside the blood vessels

  3. Diverticular disease • 15-20% with DD are symptomatic • Of those with symptoms: 25% develop diverticulitis and massive bleeding • F>M

  4. Diverticulitis • 1. Uncomplicated • 2. Complicated • Fistula …think pneumaturia/faecaluria/UTIS • Perforation • Obstruction/strictures • Massive bleeding

  5. Symptoms/Signs of diverticulitis • LLQ abdominal pain • Diarrhoea • Fever • Localised peritonitis • Blood tests: WCC and CRP useful • Consider Cr ( if CT requested)

  6. Algorithm of assessment and management DIVERTICULITIS CT-iv and po contrast Complicated Uncomplicated Mild Hospital admission ? Abs and review Severe IV Abs Consider surgery if recurrent Percutaneous drain Surgery

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