The Best Ways to Treat Diverticulitis
Managing Diverticular Disease
Stop The Pain. Manage Your Diverticular Disease And Live A Pain Free Life. No Pain, No Fear, Full Control Normal Life Again. Diverticular Disease can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.
Diverticular disease has two clinical forms, diverticulosis and diverticulitis. People with diver-ticulosis have multiple, noninflamed diverticula (outpouches of the intestinal mucosa through the circular smooth muscle of the bowel wall). Usually diverticulosis is asymptomatic and does 300 Diverticular Disease not require treatment. Diverticulitis, in contrast, occurs when the diverticula become inflamed or microperforated. Diverticular disease usually occurs in the descending and sigmoid colon and is accompanied by signs of inflammation. Mortality and morbidity are related to complications of diverticulosis such as diverticulitis and lower gastrointestinal (GI) bleeding, which occur in 10 to 20 of patients with diverticu-losis during their lifetime. The lifetime recurrence is 30 after the first episode of diverticulitis and more than 50 after a second episode.
Inflammatory change in the pericolic fat (Fig. 4) is the hallmark of diverticulitis on CT, and is seen in 98 of cases. The extent of the inflammatory reaction is related to the size of the perforation, bacterial contamination, and the host response. Mild cases may manifest as areas of slightly increased density of fat adjacent to the involved colon or as fine linear strands with small fluid collections or bubbles of extraluminal air. In sigmoid diver-ticulitis, the fluid is typically decompressed into the inferior interfascial plane. Due to hypervascularity of the inflamed area, contrast-enhanced CT scans often reveal engorged mesenteric vessels in the involved pericolic fat. Fig.4. Acute diverticulitis. There are diverticula and mural thickening of the sigmoid colon with inflammatory change and gas collection (large arrow) in the sigmoid mesocolon. Fluid is also present in the combined interfascial plane (small arrows) Fig.4. Acute diverticulitis. There are diverticula and mural...
In the treatment of diabetes and hyperlipidemia and the latter in the treatment of gastrointestinal problems such as constipation, diverticulitis and may even be protective against bowel cancer. The fiber era in the United States began with a paper by Burkitt, Walker and Painter (9) which summarized the view that a high fiber diet prevented or protected against the disease conditions most prevalent in this country. Heaton (33) has pointed out that dietary fiber exerts its effects throughout the length of the gastrointestinal tract. In the mouth it stimulates salivary flow and in the stomach it dilutes the contents and prolongs storage. In the small intestine fiber is a diluent of the contents and delays absorption and in the large intestine it acts as a diluent, bacterial substrate and traps water. Finally, dietary fiber softens and enlarges the stool. To expand on some of the above, constipation is relieved by the addition of fiber to the diet, the most effective fiber being wheat...
Women in whom a particular disease process is suspected, such as adenomyosis, uterine leiomyomata, irritable bowel syndrome, interstitial cystitis, diverticulitis, or fibromyalgia should undergo further diagnostic testing and disease-specific treatment.
Pitfalls include untagged stool (inhomogeneous, moves in position), complex folds (3D is helpful), extrinsic compression (2D is helpful), ileocecal valve (combined 2D and 3D evaluation), while flat lesions can be difficult to detect. Evaluation of the sigmoid can be difficult in patients with extensive diverticulosis and muscular hypertrophy. Collapsed bowel segments should be scrutinized in the other position. It is important to report the quality of the examination (distension, tagging) and whether a colonoscopy is indicated.
Diverticular disease is rare in those under 40 years of age. When the disorder does occur before age 40, it can usually be attributed to a congenital predisposition. From 30 to 60 of people with diverticular disease are between 60 and 80 years old. As people age, structural changes in both genders occur in the muscular layers of the colon, which places the elderly at risk for the disease. By age 85 years, two-thirds of the population has the condition. Diverticular disease is primarily a disease of industrialized Western societies, probably because diet may influence the prevalence. The male-to-female ratio is equal. Ethnicity and race have no known effects on the risk for diverticular disease.
For uncomplicated diverticulosis, a diet high in vegetable fiber is recommended. If constipation is a problem, bulk-forming laxatives and stool softeners are often prescribed to decrease stool transit time and minimize intraluminal pressure. For diverticulitis, care centers on resting the bowel until the inflammatory process subsides. Bedrest is recommended to decrease intestinal motility, and oral intake is restricted, with supplemental intravenous fluid administration followed by a liquid diet and, eventually, a bland, low-residue diet. After the inflammatory episode resolves, the patient is advanced to a high-fiber diet to prevent future acute inflammatory attacks. 302 Diverticular Disease SURGICAL. Surgical intervention may be required if the diverticular disease becomes symptomatic and is not relieved with conservative treatment. Surgery is mandatory if complications develop, such as hemorrhage, bowel obstruction, abscess, or bowel perforation. A colon resection with...
With torsion and infarction of these appendices and can simulate diverticulitis if they occur in the sigmoid colon, and appendicitis if they are located in the proximal colon. CT reveals a characteristic small, round, or oval fat-containing mass with associated inflammatory reaction of the pericolic fat (Fig. 5) 12 .
The most common causes of IDA are menstrual blood loss and the increased iron requirements of pregnancy. Pathological bleeding, particularly gastrointestinal (GI) bleeding, is a common cause of iron depletion in men. Iron malabsorption can lead to IDA. Pathological causes include GI ulcers, hiatal hernias, malabsorption syndromes such as celiac disease, chronic diverticulosis, varices, and tumors. Other causes include surgeries such as partial gastrectomy and the use of prosthetic heart valves or vena cava filters.
Risk factors that may have contributed to the bleeding include and nonsteroidal anti-inflammatory drugs, anticoagulants, colonic diverticulitis, renal failure, coagulopathy, colonic polyps, and hemorrhoids. Patients may have a prior history of hemorrhoids, diverticulosis, inflammatory bowel disease, peptic ulcer, gastritis, cirrhosis, or esophageal varices.
Angiodysplasia and diverticular disease of the right colon accounts for the vast majority of episodes of acute lower GI bleeding. Most acute lower GI bleeding originates from the colon however 15 to 20 percent of episodes arise from the small intestine and the upper GI tract. B. Elderly patients. Diverticulosis and angiodysplasia are the most common causes of lower GI bleeding.
In most patients, ureteral obstruction results from an acute process with associated symptoms. Some controversy exists as to which imaging studies are best for investigating suspected ureteral obstruction. In most hospitals in the United States, non-contrast helical computed tomography (CT) is preferred because it is safe and extremely rapid, and the accuracy rate for detecting ureter-al stones, the most common cause of ureteral obstruction, exceeds that of other imaging studies. Other causes of acute abdominal pain, such as appendicitis, leaking aortic aneurysm, and diverticulitis, can also be readily diagnosed and occur in 13-19 of cases. Non-contrast helical CT has an overall accuracy of 97 for diagnosing ureteral stone disease 1-8 . This far exceeds the accuracy of intravenous urography (IVU) or ultrasonography (US) (See Table 1). Regardless of composition, virtually all ureteral stones have high attenuation values, making them readily detectable with CT. Nonmineralized matrix...
It is not unusual for patients referred for constipation to present to the specialist having had at least one (and possibly multiple) full anatomic evaluation(s) of the bowel, including computed tomography (CT) scans, contrast studies, and colonoscopies. The reported results of these studies are usually normal, except for varying degrees of diverticulosis coli. Usually, a careful history suffices to reveal the underlying problem. Issues to be addressed in the history include bowel habits, frequency of bowel movements, ease or difficulty with evacuation, chronicity, childhood bowel habits, medications, and surgery. Careful attention to the use of pain medicines is required, because narcotic use is an often-overlooked cause of constipation-related problems.1 Physical examination is typically unremarkable, but occasional patients can have palpable ascending or sigmoid colons secondary to stool accumulation. Rectal examination is often normal, but the presence of a large amount of firm...
Although people with IBS have a gastrointestinal (GI) tract that appears normal, colonic smooth muscle function is often abnormal. The autonomic nervous system, which innervates the large bowel, fails to provide the normal contractions interspaced with relaxations that propel stool smoothly forward. Excessive spasm and peristalsis lead to constipation or diarrhea, or both. Generally patients with IBS have either diarrhea- or constipation-predominant syndrome. Although complications are unusual, they include diverticulitis, colon cancer, and chronic
Isolated intestinal neuronal dysplasia type B is found in 58.5 of constipated adults.27 A milder form was seen in about 14.6 of all patients, and these patients may subsequently develop diverticulosis.27 Type A is rare, occurring in less than 5 of cases, and is characterized by aplasia or hypoplasia of the adrenergic innervation.
Diverticular Disease Diverticula are small bulges or pouches that develop in the colon. These pouches form when the colon strains to move hard stool, and the increased pressure pushes through weak spots in the lining of the colon. This condition may result from eating a diet that is low in fiber. If there are no symptoms or mild symptoms, the condition is called diverticulosis. If the pouches become infected or inflamed such as when stool or bacteria become trapped inside them the condition is known as diverticulitis. Diverticular disease occurs mainly in developed countries such as the United States, where people regularly consume low-fiber processed foods. Diverticulosis usually does not cause symptoms, although some people may experience tenderness or pain in the lower abdomen. Others may have mild cramps, bloating, and alternating bouts of constipation and diarrhea. Eating a well-balanced diet (see page 49) that is low in fat and high in fiber, taking fiber supplements, and taking...
The term 'acute abdomen' defines a clinical syndrome characterized by a history of hitherto undiagnosed abdominal pain lasting less than one week. A large number of disorders, ranging from benign, self-limited diseases to conditions that require immediate surgery, can cause acute abdominal pain. Eight conditions account for over 90 of patients who are referred to hospital and are seen on surgical wards with acute abdominal pain acute appendicitis, acute cholecystitis, small bowel obstruction, urinary colic, perforated peptic ulcer, acute pancreatitis, acute diverticular disease, and non-specific, non-surgical abdominal pain ('dyspepsia', 'constipation'). US and CT are both accurate techniques for diagnosing liver abscesses. US usually reveals a round or oval hy-poechoic mass with low-level internal echoes. Although the lesion may mimic a solid hepatic mass, the presence of through transmission is a clue to its cystic nature. Normally, pyogenic liver abscesses are the result of seeding...
Dark red rectal bleeding and melena occurred over several days, 4 weeks prior to the patient's referral. Chest pain occurred during this period diagnosed as angina. Colonoscopy revealed diverticular disease of the sigmoid colon and a lobulated polyp protruding through the ileocecal valve. The polyp intermittently retracted from view, and examination beyond the ileocecal valve confirmed its attachment to the terminal ileum by a broad pedicle. Biopsy showed nonspecific inflammatory changes. A small bowel series confirmed the polyp in the terminal ileum and suggested this was a solitary lesion.
Contraindications Hemorrhagic tendencies (including hemophilia), clients with frail or weakened blood vessels, blood dyscrasias, ulcerative lesions of the GI tract (including peptic ulcer), diverticulitis, colitis, SBE, threatened abortion, recent operations on the eye, brain, or spinal cord, regional anesthesia and lumbar block, vitamin K deficiency, leukemia with bleeding tendencies, thrombocytopenic purpura, open wounds or ulcerations, acute nephritis, impaired hepatic or renal function, or severe hypertension. Hepatic and renal dysfunction. In the presence of drainage tubes in any orifice. Alcoholism. Special Concerns Use with caution in menstruation, in pregnant women (because they may cause hypoprothrombinemia in the infant), during lactation, during the postpar-tum period, and following cerebrovas-cular accidents. Geriatric clients may be more susceptible to the effects of anticoagulants.
However, unsuccessful demonstration of a Meckel's di-verticulum on enteroclysis despite a detailed examination is not unusual. The reasons for this include stenosis of the ostium, filling with intestinal contents, rapid emptying, or small size. CT has been reported to be of value in Meckel's diverticulitis and infracted Meckel's diverticulum.
Laparotomy revealed a pelvic abscess contained by an inflmed segment of sigmoid colon, the left side of the upper rectum, and the side wall of the pelvis. There was marked diverticulosis proximal to the inflmmatory mass, which affected most of the descending colon. The upper rectum, sigmoid, and descending colon were resected. An extraperitoneal anastomosis was performed with a circular stapler (later measured at 9 cm). Irrigation suction drains were placed in the bed of the previous abscess. Postoperative recovery was satisfactory.
Other malignancies of the colon and rectum are rare, and include soft tissue cancers, gastrointestinal stromal tumors and extension of tumor from adjacent organs and peritoneal metastases. The differentiation between diver-ticulitis and cancer may be difficult, particularly in the sigmoid colon. The presence of fluid in the root of the sigmoid mesentery, engorgement of adjacent sigmoid mesenteric vasculature and a tethered or sawtooth lumi-nal configuration favors the diagnosis of diverticulitis. Conversely, the presence of enlarged pericolic lymph nodes, mural thickness greater than 1.5 cm, and an abrupt transition zone raises the possibility of colon cancer. Ischemic colitis may also lead to bowel wall thickening, but the clinical history (e.g. extensive atherosclerosis) and imaging findings (no enlarged lymph nodes, more gradual transition) help to differentiate. At the rectosig-moid, endometriosis may simulate colorectal cancer, but the location (often anterior, adjacent to the...
Chronic focus of infection Dental abscess (usually the patient has poorly maintained dentition on physical exam, with one or more sensitive teeth however, occult abscess formation without signs or symptoms has also been reported), chronic sinusitis, chronic dermatophytosis, candidiasis, intestinal parasitosis, diverticulitis.
The combination of right lower quadrant inflammation, a phlegmon, and an abscess adjacent to the cecum is suggestive but not diagnostic of appendicitis. Indeed, if an abnormal appendix or an appendicolith is not shown, the differential diagnosis must also include Crohn's disease, cecal diverticulitis, ileal diverticulitis, perforated cecal carcinoma, and pelvic inflammatory disease. A barium enema is required to visualize the appendix and evaluate the colon and terminal ileum for primary intestinal disease. Abscesses may be found in locations distant from the ce-cum because of the length and position of the appendix and the patterns of fluid migration in the peritoneal cavity.
Acute peritonitis is inflammation of the peritoneum or peritoneal fluid from bacteria or intestinal contents in the peritoneal cavity. Secondary peritonitis results from perforation of a viscus caused by acute appendicitis or diverticulitis, perforation of an ulcer, or trauma. Primary peritonitis refers to peritonitis arising without a recognizable preceding cause. Tertiary peritonitis consists of persistent intra-abdominal sepsis without a discrete focus of infection, usually occurring after surgical treatment of peritonitis.
Selective mesenteric angiography detects arterial bleeding that occurs at rates of 0.5 mL per minute or faster. Diverticular bleeding causes pooling of contrast medium within a diverticulum. Bleeding angiodysplastic lesions appear as abnormal vasculature. When active bleeding is seen with diverticular disease or angiodysplasia, selective arterial infusion of vasopressin may be effective.
The abdominal examination may detect excessive stool or gaseous distention and the presence of surgical scars that are evidence of neoplasic or inflammatory bowel diseases. Palpation may reveal a soft mass in patients with a dilated rec-tosigmoid filled with stool, a tender mass in the left lower quadrant, suggestive of a diverticular disease, or a hard mass that is more characteristic of a neoplasm. Percussion can differentiate gaseous distention from ascites. Finally, auscultation may reveal hyperactive waves in patients with abdominal distention, which can be visualized in the relaxed patient and characteristic of