Diverticular Disease

Nearly 80% of sufferers with diverticula are asymptomatic except for chronic constipation. Of those who develop other symptoms, the most common presentation is definitely an intermittent and unpredictable griping lower abdominal discomfort (diverticulitis). Extra features of the presentation depend on which of the two main complications of diverticula that the affected individual develops.

A patient who grows diverticulitis (see later discussion) might present with fever and with signs or symptoms and signs of peritoneal irritation (guarding, rebound tenderness, absence of bowel sounds). A affected individual who grows diverticular bleeding might present with either frankly bloody stools or stools which are good for occult blood.

Diverticulosis results from an acquired deformity of the colon in which the mucosa and submucosa herniate via the underlying muscularis. This really is a illness of contemporary affluent existence. A rarity at the turn of the century, these days it afflicts 30% of adults in the U.S. population. Its incidence increases with age, beginning from about 40 years.

Epidemiologic studies recommend how the consumption of extremely refined foods and less fiber, with resulting elevated prevalence of chronic constipation, might be responsible for the elevated prevalence of diverticular illness.

Diverticulosis: Most acquired diverticula occur in the colon; the descending colon and sigmoid (left side) are involved in > 90% of cases. Both structural and functional factors are considered to contribute towards the improvement of diverticulosis.

Acquired abnormalities in colonic wall connective tissue are believed to become the structural basis of diminished resistance to mucosal and submucosal herniation. The functional abnormality is considered to be related to chronic bowel problems and the improvement of a transmural pressure gradient from colonic lumen to peritoneal space as a result of vigorous muscle contraction of the colonic wall.

This functional abnormality is most likely related towards the alter in dietary habits; decreased dietary fiber makes forward propulsion of feces at typical transmural pressures more hard. This increased muscle contraction, which contributes towards the development of diverticular disease, can also be considered to cause the abdominal pain that's the cardinal symptom of uncomplicated diverticular illness.

The discomfort may last hours to days, with sudden relief on passing flatus or feces. Bowel problems or diarrhea and flatulence are typical findings during such episodes, leading towards the suggestion that there is a relationship between irritable bowel syndrome and the improvement of diverticulosis.

Treatment of the discomfort of diverticular illness with opioids is contraindicated simply because they directly raise intraluminal pressure and hence might increase the risk of perforation.

Diverticular Bleeding: Diverticula are a source of bleeding in 3-5% of sufferers with diverticulosis. Branches of the colonic intramural arteries (vasa recta) are closely associated with the diverticular sac, presumably leading to occasional rupture and bleeding. This may be the most frequent cause of massive reduced GI bleeding in the elderly. Diverticular bleeding is typically painless and not believed to be connected having a focus of inflammation.

Diverticulitis: This most frequent complication of diverticulosis grows when a focal area of inflammation occurs in the wall of a diverticulum in response to irritation by fecal material. The patient develops symptoms of abdominal pain and fever with a chance of progression to abscess with or without perforation.

The perforations generally are self-contained, but the potential for subsequent fistula formation and intestinal obstruction is high. About one fifth of all people with diverticular disease develop one of the two main complications-diverticular bleeding or diverticulitis-which must be distinguished from carcinoma, inflammatory bowel illness, and ischemic injury resulting from diffuse atherosclerosis.