Divertiuclitis

Question 1

Epidemiology

Answer 1

Asymptomatic diverticulosis is a common condition. The incidence of diverticulosis increases with age, from less than 5% before age 40 years to greater than 65% by age 85 years.

Diverticulitis appears to be more common in patients with the largest number of diverticula; 15-20% of those with diverticulosis develop diverticulitis. While diverticulitis is generally considered a disease of the elderly population, as many as 20% of patients with diverticulitis are younger than 50 years.

Diverticulosis occurs more frequently in Western countries and industrialized societies.

Question 2

aetilogy

Answer 2

not yet conclusive, but it appears to be associated with a low-fiber diet, constipation, and obesity.

Question 3

Pathogenesis

Answer 3

small mucosal herniations protruding through the intestinal layers and the smooth muscle along the natural openings created by the vasa recta or nutrient vessels in the wall of the colon.

Creates small pouches. Diverticula can occur anywhere in the gastrointestinal tract but are usually observed in the colon.

The sigmoid colon has the highest intraluminal pressures and is most commonly affected. Diverticulosis is defined as the condition of having uninflamed diverticula.

Question 4

natural history

Answer 4

mostly assymptomatic

Question 5

clinical manefestations

Answer 5

pain or tenderness in the left lower quadrant of the abdomen and fever.
Peritoneal signs (eg, rebound or guarding) may be present, particularly with abscess or free perforation.
Fistulas may manifest as pneumaturia, feculent vaginal discharge, or a cutaneous or myofascial infection of the abdominal wall, perineum, or upper leg.
Patients with bowel obstruction have nausea, vomiting, and abdominal distention. Bleeding is uncommon.
Stage I: Small or confined pericolic or mesenteric abscess
Stage II: Large abscess, often confined to the pelvis
Stage III: Perforated diverticulitis causing generalized purulent peritonitis
Stage IV: Rupture into the peritoneal cavity with fecal contamination causing generalized fecal peritonitis

Question 6

Symtoms

Answer 6

Left lower quadrant pain (70% of patients), Change in bowel habits, Nausea and vomiting, Constipation, Diarrhea, Flatulence, Bloating

Question 7

Signs

Answer 7

Left lower quadrant pain, abdominal distension

Question 8

Complications

Answer 8

25% may develop abscess, free intraperitoneal perforation -> peritonitis, bowel obstruction, or fistulas. The most common fistulas involve the bladder but may also involve the small bowel, uterus, vagina, abdominal wall, or even the thigh.

Question 9

Prognosis

Answer 9

About 80% of patients can be treated successfully without surgery.