Diverticular disease Appendicitis
Definitions
Diverticula out-pouching of colon
Most common acute abdomen condition
True all layers involved (mucosa serosa) requiring surgery
False only mucosa/submucosal (common)
Diverticula + Sx Diverticular disease Common in young people aged 10-20 yrs
Diverticulitis = infection that becomes trapped inside one of the bulges
Diverticulosis = multiple out-pouchings of the bowel wall, most commonly in
Signs + symptoms
the sigmoid colon Abdominal pain peri-umbilical abdominal
Usual site: between taenia coli, where vessels pierce the muscle to supply the
mucosa, therefore rectum (lacks taenia coli) is often spared pain (visceral stretching of appendix
Aetiology
Due to high pressures (e.g. large stools), increasing age (5% by 40 yrs, 50% by 80
lumen + appendix is mid-gut structure)
yrs), smoking, obesity, NSAID use, Hx of constipation RIF due to localised parietal peritoneal
Diverticular disease
Signs + symptoms inflammation
Altered bowel habit + bleeding + abdominal pain
Complications diverticulitis, haemorrhage, development of fistula, perforation of
Pain worse on coughing/going over speed
faecal peritonitis, perforation + development of abscess bump
Dx presentation in clinic either: colonoscopy, CT cologram/barium enema
Acutely unwell patient plain AXR + erect CXR will identify perforation Children typically can’t hop on the right
Abdominal CT scan w/ oral + IV contrast acute inflammation/abscess formation?
Severity classification Hinchey
leg due to pain
I Para-colonic abscess II Pelvic abscess III Purulent peritonitis IV Faecal peritonitis Other vomiting once/twice, marking
Rx
1. Increase dietary fibre intake vomiting is unusual, mild pyrexia (37.5-
2. Mild diverticulitis attacks Abx
3. Acute, repetitive attacks segmental resection
38oc)
4. Hinchey IV resection + stoma High temperature = mesenteric adenitis
< severe = laparoscopic washout + drain insertion
Diverticulitis 50% anorexia, peri-umbilical pain +
Signs + symptoms
LIF pain + tenderness
nausea RIF pain
Anorexia, nausea + vomiting Dx raised inflammatory markers + Hx + O/E
Diarrhoea
Features of infection (pyrexia, raised WCC + CRP) findings
Complications abscess formation, peritonitis, obstruction, perforation Urine analysis = mild leucocytosis + no rise in
Mx
Mild attacks Oral Abx nitrates
More significant attacks managed in hospital. Patients are made nil by mouth IV
fluids, IV Abx (typically a cephalosporin + metronidazole) Mx
Appendectomy open/laparoscopically (Rx of
choice)
Definitions
Diverticula out-pouching of colon
Most common acute abdomen condition
True all layers involved (mucosa serosa) requiring surgery
False only mucosa/submucosal (common)
Diverticula + Sx Diverticular disease Common in young people aged 10-20 yrs
Diverticulitis = infection that becomes trapped inside one of the bulges
Diverticulosis = multiple out-pouchings of the bowel wall, most commonly in
Signs + symptoms
the sigmoid colon Abdominal pain peri-umbilical abdominal
Usual site: between taenia coli, where vessels pierce the muscle to supply the
mucosa, therefore rectum (lacks taenia coli) is often spared pain (visceral stretching of appendix
Aetiology
Due to high pressures (e.g. large stools), increasing age (5% by 40 yrs, 50% by 80
lumen + appendix is mid-gut structure)
yrs), smoking, obesity, NSAID use, Hx of constipation RIF due to localised parietal peritoneal
Diverticular disease
Signs + symptoms inflammation
Altered bowel habit + bleeding + abdominal pain
Complications diverticulitis, haemorrhage, development of fistula, perforation of
Pain worse on coughing/going over speed
faecal peritonitis, perforation + development of abscess bump
Dx presentation in clinic either: colonoscopy, CT cologram/barium enema
Acutely unwell patient plain AXR + erect CXR will identify perforation Children typically can’t hop on the right
Abdominal CT scan w/ oral + IV contrast acute inflammation/abscess formation?
Severity classification Hinchey
leg due to pain
I Para-colonic abscess II Pelvic abscess III Purulent peritonitis IV Faecal peritonitis Other vomiting once/twice, marking
Rx
1. Increase dietary fibre intake vomiting is unusual, mild pyrexia (37.5-
2. Mild diverticulitis attacks Abx
3. Acute, repetitive attacks segmental resection
38oc)
4. Hinchey IV resection + stoma High temperature = mesenteric adenitis
< severe = laparoscopic washout + drain insertion
Diverticulitis 50% anorexia, peri-umbilical pain +
Signs + symptoms
LIF pain + tenderness
nausea RIF pain
Anorexia, nausea + vomiting Dx raised inflammatory markers + Hx + O/E
Diarrhoea
Features of infection (pyrexia, raised WCC + CRP) findings
Complications abscess formation, peritonitis, obstruction, perforation Urine analysis = mild leucocytosis + no rise in
Mx
Mild attacks Oral Abx nitrates
More significant attacks managed in hospital. Patients are made nil by mouth IV
fluids, IV Abx (typically a cephalosporin + metronidazole) Mx
Appendectomy open/laparoscopically (Rx of
choice)
