1522
Diverticulum relates to a thin-walled outpouching of the mucosa and serosa, absent the muscularis.
Pouches, called diverticula, bulge outward from the colon, and when inflamed or infected results in diverticulitis.
Diverticula are asymptomatic unless inflamed.
About half of Americans ages 60 to 80 have diverticulosis.
After age 80 years almost every one has diverticula.
Diverticulosis refers to the presence of many diverticula.
Diverticulitis refers to the presence of inflammation in diverticula.
Approximately one to 4% of patients with diverticulosis will develop acute diverticulitis in their lifetime, which typically presents his left lower quadrant pain associated with nausea, vomiting, fever, and leukocytosis.
Hospitalization rates for diverticulitis are increasing because of a disproportionally great increase in the prevalence of diverticulitis and individuals younger than 50 years.
Diverticula form from herniation of colon mucosa and submucosa through the defects in the circular muscle layers within the colon wall.
The sigmoid colon is the most frequent site of diverticular disease because it has the smallest colonic diameter and pressure is directly proportional to wall tension, and inversely proportional to the radius of the bowel.
Among patients with the diverticula, 65% have diverticula limited to the sigmoid colon, 25% have diverticular in the sigmoid colon and other locations, and 4% have colonic diverticula that are all proximal to the sigmoid colon.
True diverticula are composed of the entire wall of the intestine, while false diverticula herniate the mucosa and submucosa.
Diverticular how often present at the sites of penetrating blood vessels in the colon.
A common condition affecting many individuals with an estimated 2,682,000 outpatient clinic visits in 2009.
There is an increase in risk in siblings, and in patients with gene variants associated with diverticular disease.
There is also an increased risk of diverticular disease in inherited connective tissue disorders: polycystic kidney disease, Marfan syndrome, and Ehlers-Danlos syndrome.
Vegetarian diet and increased physical activity is protective of diverticular disease.
Medications that may have a protective effect are calcium channel blockers statins and higher vitamin D levels.
In 2009 it was the most common G.I. related to hospitalization discharge code.
Most frequent detected anomaly on colonoscopy.
Can be asymptomatic.
May present with bleeding, or inflammation, diverticulitis.
It is suggested that diverticula formation occurs due to altered bowel motility leading to increased intraluminal pressure causing mucosal outpouching adjacent to the vasa recta.
With aging there is degeneration of the mucosal wall as well as increased colonic pressure that bulges in areas of insertion of the vasa recta that results in the development of diverticulosis.
The rates of complications of bleeding is low as most cases resolve spontaneously.
Benefiber or Metamucil can improve fiber: A tablespoon of any of these adds about 5 to 6 grams of fiber to the diet.
Vegetarian diets reduce the risk of hospitalization and death from diverticular disease.
Genetics play a significant role in the development of diverticular disease as demonstrated by twin studies.
Specific genes TNFSF15 SNP rs7848647 implicated in diverticulosis.
Patients with diverticulosis have higher colonic pressures than in control patients.
It is assumed that longer stool transit time resulting in development of diverticular disease from increased wall pressure.
Theoretically felt that diet alterations of low fiber in Western diets compared with that of Asian and African diets.
Risk factors for diverticular disease include age older than 65 years, genetic factors such as variant in the tumor necrosis factor super family member 15 gene, connective tissue diseases, such as polycystic kidney disease, Marian syndrome, or Ehlers-Danlos syndrome, body mass index, 30 or greater, use of opioids, steroids, and nonsteroidal, anti-inflammatory medications hypertension, and type two diabetes.
Increased risk associated with physical inactivity, constipation, smoking, obesity and use of nonsteroidal anti-inflammatory drugs.
A motility theory states that neural degradation that occurs with age in the myenteri plexus and in the myenteric glial cells and interstitial cells of cajal are related to diverticulosis.
The loss of neurons results in uncoordinated contractions and increased pressure resulting in diverticular disease.
Long-standing fecal stasis may result in a chronic microbiome dysbiosis which can result in a chronic inflammatory state.
In diverticular disease there is an increase in microscopic inflammation from lymphocytic and neutrophilic infiltration as well as enhanced expression of tumor necrosis factor alpha.
Hospitalization for diverticulitis is more common in white women.
Accounts for 23% of acute lower gastrointestinal bleeding episodes.
Thought to result from colon’s exposure to excessive intraluminal pressure.
Classified as true or false.
True diverticula consist of outpouchings of all layers of bowel wall, are probably congenital and are less common than false diverticula.
False diverticula are outpouchings of the mucosa and submucosa through the bowel wall weakened areas where the vasa recta enter through the muscularis propia to provide mucosal nutrients.
In Western countries most diverticular disease is in the sigmoid colon.
In Asia right sided diverticulosis is the predominant site of the lesions.
The risk of being hospitalized for diverticulitis is three times that associated with diverticular bleeding.
Diagnosis of diverticulosis can be made on clinical symptom basis, or more frequently with the confirmation test done radiologically or by colonoscopy.
Previously barium enema was used for the diagnosis of diverticular disease, however currently CT is the standard diagnostic tool.
CT of the abdomen and pelvis and CT colonography can diagnose diverticular disease, its extent and its complications.
The sensitivity of CT of the abdomen/pelvis in acute diverticulitis is 94%, with a specificity of 99%.
The main diagnostic tool to diagnose diverticicular disease is a colonoscopy.
Asymptomatic diverticular disease is a frequent incidental finding on screening colonoscopy.
In acute diverticulitis colonoscopy is not used as there is a concern for possible perforation related to insufflation.