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Diverticulitis - Wikipedia, the free encyclopedia

Diverticulitis

From Wikipedia, the free encyclopedia

Diverticulitis
Classification and external resources
ICD-10 K57.
ICD-9 562
DiseasesDB 3876
MedlinePlus 000257
eMedicine med/578 

Diverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches (diverticula) on the outside of the colon. Diverticulitis results if one of these diverticula becomes inflamed.

Contents

[edit] Causes

The development of colonic diverticulum is thought to be a result of raised intraluminal colonic pressures. The sigmoid colon (Section 4) has the smallest diameter of any portion of the colon, and therefore the portion which would be expected to have the highest intraluminal pressure. The postulate that a lack of dietary fiber, particularly non-soluble fiber* (also known in older parlance as "roughage") predisposes individuals to diverticular disease is supported within the medical literature.[1] [2]

It is thought that mechanical blockage of a diverticulum, possibly by a piece of feces or food particles, leads to infection of the diverticulum.[citation needed]

Large bowel (sigmoid colon) showing multiple diverticula. Note how the diverticula appear on either side of the longitudinal muscle bundle (taenium).
Large bowel (sigmoid colon) showing multiple diverticula. Note how the diverticula appear on either side of the longitudinal muscle bundle (taenium).

[edit] Presentation

Patients often present with the classic triad of left lower quadrant pain, fever, and leukocytosis (an elevation of the white cell count in blood tests). Patients may also complain of nausea or diarrhea; others may be constipated.

Less commonly, an individual with diverticulitis may present with right-sided abdominal pain. This may be due to the less prevalent right-sided diverticula or a very redundant sigmoid colon.

[edit] Symptoms

[edit] Diverticulitis

The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause,nausea, vomiting, feeling hot while having no temp., cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications. Diverticulitis worsens throughout the day, as it starts as small pains and slowly turns into vomiting and sharp pains.

[edit] Diverticulosis

Most people with diverticulosis do not have any discomfort or symptoms; however, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis.

[edit] Diagnosis

The differential diagnosis includes colon cancer, inflammatory bowel disease, ischemic colitis, and irritable bowel syndrome, as well as a number of urological and gynecological processes. Some patients report bleeding from the rectum.

Patients with the above symptoms are commonly studied with a computed tomography, or CT scan.[3] The CT scan is very sensitive (98%) in diagnosing diverticulitis. In order to extract the most information possible about the patient's condition, thin section (5mm) transverse images are obtained through the entire abdomen and pelvis after the patient has been administered oral and intravascular contrast. Images reveal localized thickening and hyperemia (increased blood flow) involving a segment of the colon wall, with inflammatory changes extending into the fatty tissues surrounding the colon. The diagnosis of acute diverticulitis is made confidently when the involved segment contains diverticulae. [4] CT may also identify patients with more complicated diverticulitis, such as those with an associated abscess. It may even allow for radiologically guided drainage of an associated abscess, sparing a patient from immediate surgical intervention.

Other studies, such as barium enema and colonoscopy are contraindicated in the acute phase of diverticulitis due to the risk of perforation.

[edit] Treatment

An initial episode of acute diverticulitis is usually treated with conservative medical management, including bowel rest (ie, nothing by mouth), IV fluid resuscitation, and broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis.

Upon discharge patients may be placed on a low residue diet. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are placed on a high-fiber diet. There is some evidence this lowers the recurrence rate.

In some cases surgery may be required to remove the area of the colon with the diverticula. Patients suffering their first attack of diverticulitis are typically not encouraged to undergo the surgery, unless the case is severe. Patients suffering repeated episodes may benefit from the surgery. In such cases the risks of complications from the diverticulitis outweigh the risks of complications from surgery.

Fortunately, for most cases, diverticulitis responds quickly and completely to antibiotics when administered quickly.[citation needed]

[edit] Complications

In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open. If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal peritonitis. Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction. Also, the affected part of the colon could adhere to the bladder or other organ in the pelvic cavity, causing a fistula, or abnormal connection between an organ and adjacent structure or organ, in this case the colon and an adjacent organ.

[edit] Epidemiology

Diverticulitis most often affects middle-aged and elderly persons, though it can strike younger patients as well.[5] Central obesity may be associated with diverticulitis in younger patients, with some being as young as 20 years old.[6]

In Western countries, diverticular disease most commonly involves the sigmoid colon - section 4 - (95% of patients). The prevalence of diverticular disease has increased from an estimated 10% in the 1920s to between 35 and 50% by the late 1960s. 65% of those currently 85 years of age and older can be expected to have some form of diverticular disease of the colon. Less than 5% of those aged 40 years and younger may also be affected by diverticular disease.

Left-sided diverticular disease (involving the sigmoid colon) is most common in the West, while right-sided diverticular disease is more prevalent in Asia and Africa. Among patients with diverticulosis, 10-25% patients will go on to develop diverticulitis within their lifetimes.

Peanuts and seeds may aggravate diverticulitis.[7]

[edit] Controversy

There is no scientific evidence that suggests the avoidance of nuts and seeds prevents the progression of diverticulosis to an acute case of diverticulitis, and as such the widely held belief that small undigestable foods like seeds becoming lodged in the diverticula appears to be nothing more than an 'old wives' tale.[8] Further, in a survey of fellows of The American Society of Colon and Rectal Surgeons at least half of the surgeons responding to the survey saw no value in avoiding such foods.[9]

[edit] Celebrity cases

[edit] Cultural references

[edit] References

  1. ^ Diverticular disease
  2. ^ Diverticular Disease: Oregon Health & Science University - Portland, Oregon
  3. ^ Lee KH, Lee HS, Park SH, et al (2007). "Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography". Journal of computer assisted tomography 31 (5): 763–9. doi:10.1097/RCT.0b013e3180340991. PMID 17895789. 
  4. ^ Horton KM et. al. (Mar-Apr 2000). "CT Evaluation of the Colon: Inflammatory Disease.". Radiographics 20 (2): 399-418. PMID 10715339. 
  5. ^ Cole CD, Wolfson AB (2007). "Case Series: Diverticulitis in the Young". J Emerg Med: 363. doi:10.1016/j.jemermed.2007.02.022. PMID 17976749. 
  6. ^ Disease Of Older Adults Now Seen In Young, Obese Adults. Retrieved on 2007-11-19.
  7. ^ Avoid Certain Foods To Prevent Diverticulitis - Health News Story - KNSD. Retrieved on 2007-11-19.
  8. ^ Patient information: Diverticular disease. Retrieved on 2008-02-12.
  9. ^ Management of uncomplicated acute diverticulitis. Retrieved on 2008-02-12.
  10. ^ Desi Arnaz Biography
  11. ^ Amitabh Bachchan - India’s Superstar Undergoes Surgery
  12. ^ Diverticulitis often deadly in those Castro's age. MSNBC. Retrieved on 2008-03-30.
  13. ^ Cher Suffering Stomach Illness?
  14. ^ Cleese offers to write Obama's gags
  15. ^ Eagles' Tour Delayed, Houston Chronicle, October 4, 1994
  16. ^ Applewhite, E. J. (1977). Cosmic fishing: an account of writing Synergetics with Buckminster Fuller. New York: Macmillan. ISBN 0-02-502710-7. 
  17. ^ Ecangelista Billy Graham continúa internado y con sangrado intestinal (Spanish)
  18. ^ NL Notes: Griffey diagnosed with lung disorder
  19. ^ Diet may be to blame in Kilpatrick's illness, by Marisol Bello and Kim Norris, originally published at Detroit Free Press, 7/10
  20. ^ Roosterteeth.com reference
  21. ^ Dilma gana fuerza en el Planalto y se habla de ella como la sucesora de Lula
  22. ^ Counterculture Meets Mall Culture for Grace Slick
  23. ^ The Code Breaker
  24. ^ ESPN - Wooden OK after hospital stay during NCAA final - Men's College Basketball. Retrieved on 2007-11-25.
  25. ^ [1]

[edit] External links


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