Managing Diverticular Disease
Stop The Pain. Manage Your Diverticular Disease And Live A Pain Free Life. No Pain, No Fear, Full Control Normal Life Again. Diverticular Disease can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.
Diverticulosis refers to the presence of diverticula, or herniations of the intestinal mucosa and submucosa, most often in the sigmoid colon (Figs. 38-28 and 38-29). More than one half of patients over age 50 have incidental colonic diver-ticula. Diverticulitis is the most common complication of diverticulosis, occurring in up to 20 of patients, and results from a microperforation of a diverticulum from inspissated fecal material that often becomes a phlegmon, or a pericolic or intra-abdominal abscess. The majority of patients will have LLQ pain (93 -100 ), fever (57 -100 ), and leukocytosis (69 -83 ). Other associated features include nausea, vomiting, constipation, diarrhea, dysuria, and urinary frequency. The differential diagnosis includes IBS, IBD, colon cancer, ischemic colitis, bowel obstruction, and gynecologic and urologic disorders (ASCRS, 2000). Initial evaluation of the patient with abdominal pain and suspected diverticulitis includes CBC, urinalysis, and flat and upright...
Predisposing factors include colonic carcinoma, diverticulitis, gastrointestinal surgery, leukemia, lymphoproliferative disorders, cancer chemotherapy, radiation therapy, and more recently, AIDS.32-34 Cyclic or other neutropenia is also associated with spontaneous gas gangrene caused by C. septicum, and in such cases necrotizing enterocolitis, cecitis, or distal ileitis are commonly found. These gastrointestinal pathologies permit bacterial access to the bloodstream
In the United States, approximately 10 of the adult male population is affected by peptic ulcer disease. Five percent of the population older than 40 years has diverticular disease. Colorectal cancer is the third common malignant neoplasm (11 of all cancers) affecting American men and women. It is the second most common cause of cancer deaths in men (10 ) and the third most common cause in women (11 ). In 2007, approximately 158,410 new cases of cancer of the colon and rectum were diagnosed, and there were 52,870 deaths from colorectal cancer.
Radiograph typically shows abnormally distended bowel loops containing excessive gas. Not infrequently the typical signs are absent, especially if the bowel contains predominantly fluid an erect image may then show fluid levels that confirm the diagnosis (in the appropriate clinical setting). Air fluid levels also occur in a range of conditions, including those not requiring surgery, such as gastroenteritis and jejunal diverticulosis.
Diverticular disease and perforated peptic ulcer. The best investigation is an erect chest radiograph, which will show free gas under one hemi-diaphragm, especially above the liver on the right. If this is not possible, then an antero-posterior left lateral decubitus projection (right side raised) is a suitable alternative, or a lateral dorsal decubitus (supine) can be obtained. Whichever projection is used, the patient should be left for 20 minutes in that position to allow the air to rise, otherwise the diagnosis may be missed. The outcome is an image showing a crescent or bubble of gas in the most non-dependent part of the peritoneal cavity.
Directed segmental resection is advised when the bleeding site is identified preoperatively, as seen in adenocarcinoma of the colon or diverticular disease limited to the left colon with persistent or recurrent bleeding. The removal of identified colonic lesions does not always result in effective treatment of the underlying source of bleeding. In these cases, arteriography can be used intra-operatively as an adjunct to localize a source of bleeding, facilitate segmental resection of the bowel, and prevent blind hemicolectomy (Manning-Dimmitt et al., 2005). A transfusion requirement of greater than 4 units of packed RBCs in 24 hours and recurrent diverticular bleeding (seen in up to 30 of patients) are common indications for surgical intervention. Other factors, such as comorbidities and individual surgical practices, play a significant role in this decision (Eisen et al., 2001).
Approximately 8 to 20 ofpatients with UC and 7 to 26 of patients with CD are elderly at initial diagnosis. 1 In general, IBD presents similarly in elderly patients compared to younger individuals. Elderly patients may have more comorbid diseases, some of which may make the diagnosis of IBD more difficult. Such conditions include ischemic colitis, diverticular disease, and microscopic colitis. Increased age is also associated with a higher incidence of adenomatous polyps, but the onset of IBD at an advanced age does not appear to increase the risk of developing colorectal cancer. Elderly patients may also use more medications, particularly NSAIDs, which may induce or exacerbate colitis.
0 Primary peritonitis develops in 10 to 30 of patients with alcoholic cirrhosis.3 Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) average one episode of peritonitis every 2 years.4 Secondary peritonitis may be caused by perforation of a peptic ulcer traumatic perforation of the stomach, small or large bowel, uterus, or urinary bladder, appendicitis, pancreatitis, diverticulitis, bowel infarction,
As a screening test for colorectal cancer, FOBT has low sensitivity and specificity. Other GI lesions, including hemorrhoids, angiodysplasia, diverticular disease, and upper GI lesions, can lead to increased blood in the stool. Bleeding from colon cancers can be intermittent or undetectable, and other factors can give false-positive or false-negative readings. About 2 to 6 of asymptomatic adults have a positive FOBT test, 10 of whom have cancer and 20 to 30 , adenomas. The rest have upper GI sources of bleeding, non-neoplastic lower GI sources of bleeding (e.g., hemorrhoids), or no identified source of bleeding. The sensitivity of the FOBT in patients with colon cancer is approximately 30 .
Atrophy of the gastrointestinal mucosa occurs with a reduction in the number of stomach and intestinal glands, causing alterations in secretion, motility, and absorption. Changes in elastic tissue and colonic pressures may result in diverticulosis, which can lead to diverticulitis. Pancreatic acinar atrophy is common, as are decreases in hepatic mass, hepatic blood flow, and microsomal enzyme activity. These decreases result in an increased half-life of lipid-soluble drugs.
Diarrhea and constipation frequently alternate in patients with colon cancer or diverticulitis. Loose bowel movements are common in diseases of the left colon, whereas watery movements are seen in severe inflammatory bowel disease and protein-losing enteropathies. Floating stools may result from malabsorption syndromes. Patients with ulcerative colitis commonly have stool mixed with blood and mucus. Any inflammatory process of the small bowel or colon can manifest with blood mixed with stool or undigested food. Irritable bowel syndrome classically produces more diarrhea in the morning.
Prior to creation of a rectosigmoid pouch, anal continence should be assured. The sphincteric mechanism is tested by instilling 250 mL of fluid into the rectum. The patient must hold this for 2 to 3 hours. Preoperative sigmoidoscopy is performed to exclude colonic disease including polyposis and diverticulosis. Informed consent is obtained with a discussion of risks including but not limited to adjacent organ injury and unrecognized bowel injury. Patients are made aware that safety is paramount, and open conversion may be required for completion of the planned procedure. Patients undergo a full mechanical bowel preparation and oral antibiotics covering normal intestinal flora are given on the day prior to surgery. Preoperative antibiotic prophylaxis with an intravenous second-generation cephalosporin is given at induction of anesthesia and continues for the first postoperative day. Lower extremity compressive devices are applied. Once general anesthesia is induced, the gastric...
In a patient with an upper abdominal scar, the Veress needle should be placed in the right lower quadrant. The left lower quadrant should generally be avoided in older patients since there are usually adhesions between the sigmoid colon and the abdominal wall secondary to subclinical episodes of diverticulitis. For patient with a previously operated abdomen in multiple quadrants, an open technique is optimal.
Antimuscarinic drugs can suppress activity in the gut wall through their blocking effects on the excitatory muscarinic receptors of the smooth muscles. However, they will also reduce secretion by blocking the tonic stimulatory effects of the vagus on secretory activity, and they are not often used to block motility. Low concentrations are sometimes included in antidiarrhoeal products containing diphenoxylate. They are also occasionally used for their antispasmodic activity in the treatment of inflammatory bowel syndrome and diverticular disease.
Common triggers of IBS include stress, food intolerances (such as high fat content), and hormonal changes. Your physician may schedule tests such as a proctosigmoidoscopy to examine the inside lining of the bowel to rule out conditions such as Crohn's disease, diverticulitis, lactose intolerance, and ulcerative colitis. There are few
-41 Diverticulosis is an illness or condition where tiny pouches (called diverticula) form in the wall of the colon. The condition is often without symptoms, but when the pouches become infected or inflamed, it can be painful. When this happens, the condition is known as diverticuli-tus, which can cause fever, abdominal pain, and diarrhea.
Rectal bleeding may be manifested by bright red blood, blood mixed with stool, or black, tarry stools. Bright red blood per rectum, also known as hematochezia, can occur from colonic tumors, diverticular disease, or ulcerative colitis. Blood mixed with stool can be the result of ulcerative colitis, diverticular disease, tumors, or hemorrhoids. Ask the patient who describes rectal bleeding the following questions
Symptoms can include paravertebral pain and radicular pain.12 The ways in which an IMSCT can cause back pain are diverse and not entirely understood. Back pain may be the result of direct pressure on the surrounding dura by the expanded spinal cord. Musculoskeletal pain may be caused by derangement of the paraspinal muscle innervation. Impingement upon or involvement of a nerve root may result in radicular pain. Radicular pain may mimic other causes Thoracic pain may mimic angina, and lower thoracic roots may trigger pain similar to that of diverticulitis, cholelithiasis, or appendicitis.