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Diverticular disease (diverticulosis and diverticulitis): Difference between revisions
Diverticular disease (diverticulosis and diverticulitis) (view source)
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(Created page with "A colonic diverticulum is a sac-like protrusion of the colonic wall. The presence of many diverticula is called '''diverticulosis'''. In some cases, the diverticula may become inflamed, in which case the condition is called '''diverticulitis''' and occurs in approx. 10% of people with diverticulosis. Diverticulosis is usually asymptomatic, but it may cause symptoms like abdominal pain or lower GI tract bleeding. '''Diverticular disease''' refers to symptomatic diverticu...") |
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A colonic diverticulum is a sac-like protrusion of the colonic wall. The presence of many diverticula is called '''diverticulosis'''. In some cases, the diverticula may become inflamed, in which case the condition is called '''diverticulitis''' and occurs in approx. 10% of people with diverticulosis. | A colonic diverticulum is a sac-like protrusion of the colonic wall. The presence of many diverticula is called '''diverticulosis'''. In some cases, the diverticula may become inflamed, in which case the condition is called '''diverticulitis''' and occurs in approx. 10% of people with diverticulosis. | ||
Diverticulosis is usually asymptomatic, but it may cause symptoms like abdominal pain or lower GI tract bleeding. '''Diverticular disease''' refers to symptomatic diverticulosis or diverticulitis. 10-25% of people with diverticulosis will develop diverticulitis at some point. It's a common cause of hospital admission. | Diverticulosis is usually asymptomatic, but it may cause symptoms like abdominal pain or lower [[Gastrointestinal bleeding|GI tract bleeding]]. '''Diverticular disease''' refers to symptomatic diverticulosis or diverticulitis. 10-25% of people with diverticulosis will develop diverticulitis at some point. It's a common cause of hospital admission. | ||
Diverticular disease is mostly a disease of elderly. 60% of people at the age of 60 have diverticulosis. Diverticulosis and diverticular disease are more common in the West, likely due to our eating habits. In the Western world, diverticulosis predominantly affects the left colon, while in Asia, it predominantly affects the right colon. | Diverticular disease is mostly a disease of elderly. 60% of people at the age of 60 have diverticulosis. Diverticulosis and diverticular disease are more common in the West, likely due to our eating habits. In the Western world, diverticulosis predominantly affects the left colon, while in Asia, it predominantly affects the right colon. | ||
''Complicated diverticulitis'' refers to diverticulitis which has caused a local abscess, perforation, or peritonitis. | ''Complicated diverticulitis'' refers to diverticulitis which has caused a local abscess, [[Gastrointestinal perforation|perforation]], or [[peritonitis]]. | ||
== Etiology and pathomechanism == | == Etiology and pathomechanism == | ||
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== Complications == | == Complications == | ||
The inflamed diverticulum may perforate due to erosion of the diverticular wall by increased pressure and food particles. The perforation is usually contained by pericolic fat and mesentery, causing only a simple localised inflammation, in which case this is known as ''diverticulitis with contained (''or ''confined) perforation''. However, in rare cases, the perforation is not contained, which may cause abscess, bowel obstruction, large perforation or fistula may occur (complicated diverticulitis), which may lead to peritonitis. | The inflamed diverticulum may perforate due to erosion of the diverticular wall by increased pressure and food particles. The perforation is usually contained by pericolic fat and mesentery, causing only a simple localised inflammation, in which case this is known as ''diverticulitis with contained (''or ''confined) perforation''. However, in rare cases, the [[Gastrointestinal perforation|perforation]] is not contained, which may cause abscess, bowel obstruction, large perforation or fistula may occur (complicated diverticulitis), which may lead to peritonitis. | ||
== Clinical features == | == Clinical features == | ||
Diverticular bleeding is one manifestation of diverticular disease. This bleeding may be occult (discovered by a screening test) or acute, manifesting as haematochezia. | Diverticular bleeding is one manifestation of diverticular disease. This bleeding may be occult (discovered by a [[Faecal occult blood test|screening test]]) or acute, manifesting as haematochezia. | ||
Diverticulitis typically presents with left sided abdominal pain, especially in the left lower quadrant (the location of the sigmoid), and low-grade fever. The pain usually lasts for multiple days. Patients may also have nausea/vomiting or recent change in bowel habits. | Diverticulitis typically presents with left sided abdominal pain, especially in the left lower quadrant (the location of the sigmoid), and low-grade fever. The pain usually lasts for multiple days. Patients may also have nausea/vomiting or recent change in bowel habits. | ||
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== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
<abbr>CRP</abbr> and WBC may be elevated in diverticulitis, but not always. | <abbr>[[CRP]]</abbr> and [[WBC]] may be elevated in diverticulitis, but not always. | ||
Abdominal CT with contrast is the first choice for imaging and to establish the diagnosis. CT will also show any complications of diverticulitis. | Abdominal [[CT]] with contrast is the first choice for imaging and to establish the diagnosis. CT will also show any complications of diverticulitis. | ||
== Treatment == | == Treatment == | ||
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Uncomplicated diverticulitis usually requires no specific treatment as it resolves on its own. Oral analgesics, a liquid diet, and laxatives to keep the stool soft alleviates symptoms while waiting for resolution. | Uncomplicated diverticulitis usually requires no specific treatment as it resolves on its own. Oral analgesics, a liquid diet, and laxatives to keep the stool soft alleviates symptoms while waiting for resolution. | ||
Complicated diverticulitis should be treated as uncomplicated but with the addition of antibiotics. In Norway ampicillin + gentamicin + metronidazole are used. Larger abscesses should be drained. | Complicated diverticulitis should be treated as uncomplicated but with the addition of antibiotics. In Norway [[ampicillin]] + [[gentamicin]] + [[metronidazole]] are used. Larger abscesses should be drained. | ||
Perforated diverticulitis or diverticulitis leading to colon obstruction must be treated with surgery. | Perforated diverticulitis or diverticulitis leading to colon obstruction must be treated with surgery. | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Gastrointestinal surgery]] | [[Category:Gastrointestinal surgery]] | ||