BIOMED - Pathophysiology

🧅 𝘋𝘪𝘷𝘦𝘳𝘵𝘪𝘤𝘶𝘭𝘢𝘳 𝘋𝘪𝘴𝘦𝘢𝘴𝘦

Diverticular Disease

Diverticular disease is a very common condition wherein small pouches, or "pockets" (diverticula) form in the lining of the large bowel or colon. When there are multiple diverticula, this is called diverticulosis. When the diverticula become inflamed or inflected, this is called diverticulitis.

Diverticulosis is very common, however rare in people over 35years of age. It becomes more common with age, however the exact cause is unknown, and may be due to a combination of factors in most people. It is believed that the main factor for diverticulosis is low fibre diets, as when stool is hard and small, it takes more pressure to push it along the colon, which can lead to "blow-outs" and formation of diverticula. Therefore, people who eat high fibre diets are less likely to get diverticular disease.

Other risk factors that have been identified include:
☞ Eating a lot of red meat or fats,
☞ smoking cigarettes,
☞ high alcohol consumption,
☞ being overweight, and
☞ genetic factors.

Diverticula is most commonly formed in the left side of the colon (sigmoid colon), however those with inherited conditions associated with diverticulosis, the diverticula tend to form on the right side of the colon. It can also affect the small intestine, however that is less common.

Symptoms
Symptoms are not always present, and most people who have diverticulosis don't have any symptoms. However possible symptoms that may present include:

☞ mild abdominal cramping and/or discomfort,
☞ bloating,
☞ constipation, or
☞ diarrhoea.

However note that other bowel conditions such as irritable bowel syndrome or bowel cancer can also present with these symptoms.

Diverticulitis
Most commonly, diverticulitis presents with a constant pain in the lower left side of the abdomen. These are usually temporary and go away as the infection and inflammation settle, and may be accompanied by:

☞ fevers,
☞ nausea,
☞ vomiting and/or a loss of appetite,
changed bowel habits incl.
☞ diarrhoea or
☞ constipation

Most people will only suffer from one bout of diverticulitis in their lifetime, and usually settles within a few days without antibiotic treatment. However approximately one in seven will have another attack. These people are at higher risk of recurrent episodes, and those with severe diverticulitis or those with complications are often required to be admitted to hospital for IV antibiotics and stronger pain relief.

Diagnosis of diverticulosis and diverticulitis is achieved through a colonoscopy or CT scan, and diagnosis is usually achieved during an acute attach. CT scans show complications, and blood test results including CRP (C-reactive protein) show abnormal white blood counts or higher levels of inflammatory markers.

Complications of diverticulitis are rare, but serious, and may be life threatening. These include:

☞ Abscess (pus collection) forming in the abdomen,
☞ A perforation (hole) in the wall of the bowel that can lead to spilling of bowel contents into the abdominal cavity and an infection inside the abdomen (peritonitis),
☞ Severe (but usually painless) bleeding from the bowel,
☞ Narrowing or blockage of the large bowel,
☞ A fistula (channel) forming between the bowel and other organs, such as the bladder.

Treatment focusses on combatting infection and inflammation, pain relief, and reducing/preventing risk of complications.

A small number of people with severe complications of diverticulitis require the formation of a colonoscopy and removal of the diseased portion of the bowel. Often, this is able to be reversed and the bowel hooked back up to itself once everything has settled. However either way, bowel function can return to general health after surgery, and it is uncommon to experience further prolems from diverticular disease in the future.

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