Diverticular Disease –

Zero To Finals

What is Diverticulosis?

The presence of asymptomatic diverticula (small herniations or outpouchings of mucosa and submucosa) in the bowel wall.

What is Diverticular Disease?

The condition where diverticula cause symptoms such as intermittent lower abdominal pain and altered bowel habits without active inflammation.

What is Diverticulitis?

Inflammation of one or more diverticula, often presenting with fever, severe left lower quadrant pain, and elevated inflammatory markers.

Which anatomical part of the bowel is most commonly affected by diverticula?

The sigmoid colon.

What type of diverticula are typical in diverticular disease?

False diverticula (pseudodiverticula), involving herniation of mucosa and submucosa through defects in the muscularis propria.

What is a major risk factor for developing diverticulosis?

A low-fiber diet, along with advanced age, chronic constipation, and increased intracolonic pressure.

What is the classic location of abdominal pain in patients with diverticulitis?

Left lower quadrant (LLQ) of the abdomen.

Why does pain in diverticular disease often improve after bowel movements?

Defecation or passing flatus relieves increased intracolonic pressure.

What is the primary cause of painless, profuse lower gastrointestinal bleeding in diverticulosis?

Rupture of the vasa recta (small blood vessels) stretched over the dome of a diverticulum.

What is the diagnostic imaging modality of choice for suspected acute diverticulitis?

Contrast-enhanced CT scan of the abdomen and pelvis.

Why is colonoscopy contraindicated during an episode of acute diverticulitis?

High risk of bowel perforation due to inflamed and fragile tissue combined with air insufflation.

What is the preferred investigation to confirm diverticulosis non-urgently?

Colonoscopy (performed when acute inflammation has settled).

What dietary management is recommended for asymptomatic diverticulosis?

A high-fiber diet with adequate fluid intake to prevent constipation and reduce intracolonic pressure.

Which analgesics should generally be avoided in diverticular disease and diverticulitis?

Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, due to increased risk of bowel perforation and constipation.

What complication of diverticulitis leads to pneumaturia (air in urine) and fecaluria?

Colovesical fistula (an abnormal passage between the colon and the urinary bladder).

What is Hinchey Stage I diverticulitis?

Pericolic abscess or phlegmon confined to the immediate area around the colon.

What is Hinchey Stage II diverticulitis?

Pelvic, distant, or retroperitoneal abscess resulting from localized perforation.

What is Hinchey Stage III diverticulitis?

Generalized purulent peritonitis without free fecal contamination.

What is Hinchey Stage IV diverticulitis?

Generalized fecal peritonitis caused by frank bowel perforation.

What emergency surgical procedure is classically performed for perforated diverticulitis with fecal peritonitis?

Hartmann's procedure (resection of the affected bowel segment with an end colostomy and closure of the rectal stump).

What key laboratory findings support a diagnosis of acute diverticulitis?

Elevated white blood cell count (leukocytosis) and raised C-reactive protein (CRP).

What type of laxative is recommended for managing constipation in diverticular disease?

Bulk-forming laxatives (such as ispaghula husk).

What anatomical structure do diverticula penetrate as they herniate through the colon wall?

Deficiencies in the muscularis layer where the vasa recta penetrate the circular muscle coat.

How is a simple, mild case of acute diverticulitis without systemic features typically managed?

Outpatient management with simple analgesia, clear fluid diet, and oral antibiotics if indicated.

What visual feature characterizes diverticulosis on colonoscopy or cross-sectional imaging as illustrated in bowel diagrams?

Outpouchings or sac-like herniations protruding outwards from the colonic wall.