Diverticulitis refers to the rupturing of the diverticuli resulting to infection in the tissues that surround the colon. Diverticuli refers to small bulging sacs in the inner wall of the intestine which are as a result of pressure within the colon as a person ages. The sacs are known as diverticulum in singular and diverticuli in plural. Scholars have argued that a lower fiber diet may contribute to the development of diverticuli owing to the fact that the colon has to use more pressure to push the stool forward. Diverticulitis then occurs as a result of faces being trapped on the diverticuli resulting to the inflammation or rupturing of the diverticuli. Diverticula are most common at the end of the left colon known as sigmoid colon; however they can occur on any part in the colon.
The condition of having the diverticula in the colon is known as diverticulosis which portrays little or no symptoms at all. Chances of contracting diverticulitis increase with age and it’s very common in the western world but quite uncommon in Africa and Asia. According to PubMed Health Website more than half the population of Americans aged above 60 has diverticulitis. It has quite a number of symptoms ranging from lacking of appetite, abdominal pains to diarrhea on being diagnosed its treated with a combination of anti-spasmodic drugs and high fiber diet.
1. Definition and Causes
Diverticulitis refer to the rupturing of sac like protrusion in the colon known as diverticula, which occur as a result of pressure during bowel movement, they occur in point of weakness at the pressure points on the Mucosa or sub-mucosa. Diverticulitis can be caused by either environmental factors or epidemiological factors. The environmental causes are: low fiber diet, obesity, decreased activity, Corticosteroids, Alcohol, Caffeine intake, Cigarettes, and polycystic kidney disease. The epidemiological factors are: Age, geography, Lifestyle and Ethnicity. Diverticulitis can either be complicated which is accompanied by abscess, obstruction or abdominal fistula or un-complicated which refers to diverticulitis without complication .
2. Symptoms
The rapture of a diverticulum results to the spread of the bacteria in the colon consequently resulting to inflation of the tissues around the colon. Diverticulitis patients portray the symptoms immediately after the colon wall is inflamed and they become worse within weeks. Belly pain on the left side of that becomes worse when someone walks is the most common symptom portrayed. Other symptoms are tenderness on the belly usually on the left lower side, bloating, fever, nausea, Diarrhea, constipation and lack of appetite. A collection of pus can develop around the inflamed diverticulum consequently resulting to an abscess. Bladder infection and passing of gas in the urine can also occur as a result of inflamed diverticula eroding into the urinary bladder; however, this happens on rare occasions.
Inflammation in the colon also can result to colonic bowel obstruction. In case of an expanding diverticulum wearing away into a blood vessel this may cause rectal passage of dark colored blood. The bleeding can be continuance or discontinuous and may last for numerous days. Dysuria, frequency and urgency to urinate may also occur to a few patients owing to the proximity of the inflamed colon and the bladder. Another common symptoms is
3. Pathophysiology
Diverticulitis in general is an acquired ailment which is a result of diverculosis. The diverticula have a tendency of growing in four common areas: where the versa recta penetrate the muscular layer, on either side of the mesenteric teniae and on the mesenteric border of the two ant mesenteric teniae. The physiological and anatomic changes that occur in a patient during the development are as follows : Patients of diverticulitis have mycosis. This refers to a thickening of the muscular layer, shortening of the teniae, and luminal narrowing found in most patients of diverticulitis.
Mechanical features of the colon change with the increase in age explaining the reason as to why the disease is common in the old people. Diverticulitis is more prevalent on the left side owing to the difference in the mechanical features between the right and the left. The normal colonic wall consists of mucosa, sub mucosa, and muscle layers. The immature synthesis of collagen can result to change in bowel movement consistency. These changes may be associated to genetic predisposition such as marfan’s syndrome or aging. The thickening of longitudinal and circular muscles affects the pressure and in return the pressure exerted causes diverticulum to develop. Increased pressure raptures the diverticulum causing the inflammation of the colon wall. Thickening of both the circular and longitudinal muscles together with the deposition of elastin in the teniae coli lead to irreversible bowel contractions that consequently lead to shortening of the bowel. This affects the ability of the bowel to resist to the intraluminal pressure.
In addition to other factors like alcoholism, caffeine addiction and lifestyles like eating low fiber diet and lack of exercise diverticula develop as a result of increased intraluminal pressure generated by tonic and rhythmic contractions resulting to segmentations. If contractions happen close to each other, they may form an enclosed space and generate pressure as high as above 90mm Hg. Its important to note that the segments formed all attract different intraluminal pressure depending on the diameter of the colon and thus consequently resulting to the growth of sac like structures through the weak areas .
Fiber protects people from diverticulitis in the sense that most fiber is plant based and thus binding water to salt leading to excretion of stool that is more bulky therefore reducing the contraction and also segmentation. In addition fiber impacts on the content of colonic bacterial flora. This is essential for maintenance and growth of colonic cellular function. After the development of diverticula, continued pressure may result to localized inflammation or peritonitis. This basically what is referred to us diverticulitis. Abscess may form owing to active inflammation of the pericolic and mesenteric fat. The abscess can spread longitudinally and circumferential and the abscess is actually what are visible on a clinical picture that gives an indication of diverticulitis.
4. Diagnosis/ Expected physical examination findings in a patient with the topic diagnosis
An assessment comprising of thorough history taking and physical examination should be done to a patient who is suspected of having diverticulitis First the physician may request for a complete blood cell count, urinalysis and also flat and upright abdominal radiography, if the X-Ray is clear enough to diagnose then no other clinical test is required. When there is a query to the diagnosis the computed tomography (CT), water-soluble contrast enema, cryptography, endoscopy, and ultrasound may also be done. In patients suspected of having diverticular abscess an Ultra sound and CT scan of the abdomen can be done to detect the retention of the puss.
A diverticulitis patient has very high fever above 40 degrees. The abdomen can be tender mostly on the lower abdomen side. If urinalysis is done the sample is likely to contain gas particles. The colon of a patient with diverticulitis is seen to have abscess, fistula, and perforations on the colon wall or narrowed area on the colon .
5. Treatment
Uncomplicated diverticulitis can be managed by taking a high fiber diet and fiber supplements to prevent occurrence of constipation and also formation of more diverticula. Patients with mild symptoms of abdominal pain may benefit from anti-spasmodic drugs like atropine or dyclomine. In addition oral anti-biotic are used e.g. ciprofloxacin, Metronidazole or cephalexin amongst others .
In complicated Diverticulitis patients can be treated by taking fluids only to reduce the amount of substance passing through the colon. If the patient is portraying sever symptoms they can be hospitalized and receive IV antibiotic treatment. Surgical treatment can be elective or an emergency depending on the stage of the disease and the clinical presentation. Once a patient is diagnosed with diverticulitis the clinician mostly recommends dietary changes so as to have low fiber diet. Intake of less than 10 grams of fiber per day is recommended .In addition the doctor may recommend multi-vitamin supplements mostly in patients that have been on a low residue diet for a long period. A diverticulitis diet may include: Grain products like cereals, enriched refined bread, arrow root cookies and white rice, fruit juices and vegetables. However one is advised to avoid whole grains .
6. Conclusion
Diverticular disease can be classified as symptomatic uncomplicated disease, recurrent symptomatic disease, and complicated disease. Diverticulitis can develop complications such as rectal bleeding, rectal obstruction and diverticulitis with abdominal infection.
Diverticulitis can be prevented by change of life style. Issue like reducing alcoholism, and caffeine intake, reduction of weight and increasing the activity a person undertakes can reduce the chances of contracting the disease. Also taking high fiber diet can reduce the chances of contracting diverticulitis. In industrialist countries the incidences of diverticulitis are increasing this is owing to the lifestyle in the embraced in the industrialist countries. Like eating processed food .Diverticulosis is asymptomatic and thus the essence of frequent medical check-ups to detect the disease in early stages before they rapture. It is also more prevalent on people above the age of sixty and thus it’s advisable that the elderly manage their diet and ensure the diet has lots of fluids and fiber.
References
National Center for Biotechnology Information, U.S. National Library of Medicine . (2012, n/a n/a). PubMed Health. Retrieved February 8th, 2012, from PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001303/
Butler, J. S., Collins, C. G., & McEntee, G. P. (2010). Perforated jejunal diverticula: a case report. Journal of Medical Case reports , N/A.
Cartwright, P. (2007). Coping with Diverticulitis. London: SPCK Publishing.
Greenberger, o., Blumberg, R., & Burakoff, R. (2011). CURRENT Diagnosis & Treatment Gastroenterology, Hepatology, & Endoscopy, Second Edition. Chicago: McGraw-Hill Prof Med/Tech.
Miller, F. P., Vandome, A. F., & John, M. (2010). Diverticulitis. Saarbrücken: VDM Verlag Dr. Mueller e.K.
Nguyen, M. C. (2011). Diverticulitis. Medscape reference-Disease and drug procedures , 406.
