Wednesday, 5 August 2015

Diverticular disorder

Key points:

1. 90 % in descending colon, mostly asymptomatic and is related to lack of fibre in the diet.
2.

  • Typical clinical features: middle aged or elderly - over 40 years. 
  • Increases with age
  • Present in one in three people over 60 years
  • Diverticulitis - infected diverticula and symptomatic 
  • Constipation or alternating constipation/diarrhoea
  • Intermittent cramping lower abdominal pain in LIF
  • Tenderness in LIF
  • Rectal bleeding -- may be profuse 
  • May presente as acute abdomen or subacute obstruction 
  • Usually settles in 2-3 days 
3. Complications include
  • Abscess 
  • Perforation 
  • Peritonitis
  • Obstruction 
  • Fistula - bladder, vagina

4. Management
  • It usually responds to a high fibre diet: plenty of fluids, cereals, wholemeal, multigrain bread, fresh or stewed fruits and vegetables
  • Avoidance of constipation 
References:
- John Murtagh's general practice 8th edition 

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