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| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Diverticulitis |
| | {{Diverticulitis}} |
| ICD10 = {{ICD10|K|57||k|55}} |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| ICD9 = {{ICD9|562}} |
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| OMIM = |
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| MedlinePlus = 000257|
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| eMedicineSubj = med |
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| eMedicineTopic = 578 |
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| DiseasesDB = 3876 |
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| MeshID = D004238 |
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| {{SI}}
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| {{CMG}}
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| {{Editor Help}} | | {{CMG}}; {{AE}} [[User:zorkun|Cafer Zorkun]] M.D., PhD.; {{MM}}; {{AEL}} |
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| ==Overview==
| | {{SK}} Colonic diverticulitis, Diverticulitis of large intestine |
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| '''Diverticulitis''' is a common [[digestive disease]] particularly found in the colon (the large intestine). Diverticulitis develops from [[diverticulosis]], which involves the formation of pouches ([[diverticula]]) on the outside of the [[colon (anatomy)|colon]]. Diverticulitis results if one of these diverticula becomes [[inflamed]] or infected. <ref>[http://medical.merriam-webster.com/medical/diverticulitis Diverticulitis] entry at [[Merriam Webster]]'s Medical dictionary</ref> The colon can become infected with craters of food stuck inside, which causes abdominal pain.
| | ==[[Diverticulitis overview|Overview]]== |
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| ==Epidemiology== | | ==[[Diverticulitis historical perspective|Historical Perspective]]== |
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| Diverticulitis most often affects middle-aged and elderly persons, though it can strike younger patients as well.<ref name="pmid17976749">{{cite journal |author=Cole CD, Wolfson AB |title=Case Series: Diverticulitis in the Young |journal=J Emerg Med |volume= |issue= |pages= |year=2007 |pmid=17976749 |doi=10.1016/j.jemermed.2007.02.022}}</ref> [[Central obesity|Abdominal obesity]] may be associated with diverticulitis in younger patients, with some being as young as 20 years old.<ref name="titleDisease Of Older Adults Now Seen In Young, Obese Adults">{{cite web |url=http://www.sciencedaily.com/releases/2006/09/060923104630.htm |title=Disease Of Older Adults Now Seen In Young, Obese Adults |accessdate=2007-11-19 |format= |work=}}</ref>
| | ==[[Diverticulitis classification|Classification]]== |
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| In Western countries, diverticular disease most commonly involves the [[sigmoid colon]] - section 4 - (95% of patients). The prevalence of diverticular disease has increased from an estimated 10% in the 1920s to between 35 and 50% by the late 1960s. 65% of those currently 85 years of age and older can be expected to have some form of diverticular disease of the colon. Less than 5% of those aged 40 years and younger may also be affected by diverticular disease.
| | ==[[Diverticulitis pathophysiology|Pathophysiology]]== |
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| Left-sided diverticular disease (involving the sigmoid colon) is most common in the West, while right-sided diverticular disease is more prevalent in Asia and Africa. Among patients with diverticulosis, 10-25% patients will go on to develop diverticulitis within their lifetimes.
| | ==[[Diverticulitis causes|Causes]]== |
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| Peanuts and seeds may aggravate diverticulitis.<ref name="titleAvoid Certain Foods To Prevent Diverticulitis - Health News Story - KNSD | San Diego">{{cite web |url=http://www.nbcsandiego.com/health/4963158/detail.html |title=Avoid Certain Foods To Prevent Diverticulitis - Health News Story - KNSD | San Diego |accessdate=2007-11-19 |format= |work=}}</ref>
| | ==[[Diverticulitis differential diagnosis|Differentiating Diverticulitis from other Diseases]]== |
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| ==Causes== | | ==[[Diverticulitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| The development of colonic diverticulum is thought to be a result of raised intraluminal colonic pressures. The [[Sigmoid colon]] (Section 4) has the smallest diameter of any portion of the colon, and therefore the portion which would be expected to have the highest intraluminal pressure. The assumption that a lack of dietary fiber, particularly non-soluble fiber (also known in older parlance as "[[roughage]]") predisposes individuals to diverticular disease is supported within the medical literature.<ref>[http://www.umm.edu/altmed/articles/diverticular-disease-000051.htm Diverticular disease<!-- Bot generated title -->]</ref>
| | ==[[Diverticulitis risk factors|Risk Factors]]== |
| <ref>[http://www.ohsu.edu/health/health-topics/topic.cfm?id=8464 Diverticular Disease: Oregon Health & Science University - Portland, Oregon<!-- Bot generated title -->]</ref>
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| It is thought that mechanical blockage of a [[diverticulum]], possibly by a piece of [[feces]] or food particles, leads to infection of the diverticulum.{{Fact|date=October 2007}}
| | ==[[Diverticulitis screening|Screening]]== |
| [[Image:Diverticula, sigmoid colon.jpg|thumb|Large bowel (sigmoid colon) showing multiple diverticula. Note how the diverticula appear on either side of the longitudinal muscle bundle (taenium).]] | |
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| There is some evidence that a genetic component may be a causative factor.
| | ==[[Diverticulitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Presentation== | |
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| Patients often present with the classic triad of left lower quadrant pain, [[fever]], and [[leukocytosis]] (an elevation of the [[white blood cell|white cell]] count in blood tests). Patients may also complain of [[nausea]] or [[diarrhea]]; others may be [[Constipation|constipated]].
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| Less commonly, an individual with diverticulitis may present with right-sided [[abdominal pain]]. This may be due to the less prevalent right-sided diverticula or a very redundant sigmoid colon.
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| ==Symptoms== | |
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| ===Diverticulitis===
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| The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.
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| ===Diverticulosis===
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| Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis.
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Diverticulitis history and symptoms|History and Symptoms]] | [[Diverticulitis physical examination|Physical Examination]] | [[Diverticulitis laboratory findings|Laboratory Findings]] | [[Diverticulitis CT|CT]] | [[Diverticulitis MRI|MRI]] | [[Diverticulitis ultrasound|Ultrasound]] | [[Diverticulitis x ray|X Ray]] | [[Diverticulitis other imaging findings|Other Imaging Findings]] | [[Diverticulitis other diagnostic studies|Other Diagnostic Studies]] |
| The [[differential diagnosis]] includes [[colon cancer]], [[inflammatory bowel disease]], ischemic [[colitis]], and [[irritable bowel syndrome]], as well as a number of urological and gynecological processes. Some patients report bleeding from the rectum.
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| Patients with the above symptoms are commonly studied with a computed tomography, or [[CT scan]].<ref name="pmid17895789">{{cite journal |author=Lee KH, Lee HS, Park SH, ''et al'' |title=Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography |journal=Journal of computer assisted tomography |volume=31 |issue=5 |pages=763–9 |year=2007 |pmid=17895789 |doi=10.1097/RCT.0b013e3180340991}}</ref>
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| The CT scan is very sensitive (98%) in diagnosing diverticulitis. It may also identify patients with more complicated diverticulitis, such as those with an associated abscess. CT also allows for radiologically guided drainage of associated abscesses, possibly sparing a patient from immediate surgical intervention.
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| Other studies, such as [[barium enema]] and [[colonoscopy]] are [[Contraindication|contraindicated]] in the acute phase of diverticulitis due to the risk of perforation.
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| ===Histopathological Findings: Actinomycosis diverticulitis & abscess===
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| <youtube v=pvasI_yy3R4/>
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| ==Treatment== | | ==Treatment== |
| | [[Diverticulitis medical therapy|Medical Therapy]] | [[Diverticulitis surgery|Surgery]] | [[Diverticulitis primary prevention|Primary Prevention]] | [[Diverticulitis secondary prevention|Secondary Prevention]] | [[Diverticulitis cost-effectiveness of therapy|Cost-effectiveness of therapy]] | [[Diverticulitis future or investigational therapies|Future or Investigational Therapies]] |
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| An initial episode of acute diverticulitis is usually treated with conservative medical management, including bowel rest (ie, nothing by mouth), IV fluid resuscitation, and broad-spectrum [[antibiotics]] which cover [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis.
| | ==Case Studies== |
| | | [[Diverticulitis case study one|Case #1]] |
| Upon discharge patients may be placed on a [[low residue diet]]. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are placed on a high-fiber diet. There is some evidence this lowers the recurrence rate.
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| In some cases surgery may be required to remove the area of the colon with the diverticula. Patients suffering their first attack of diverticulitis are typically not encouraged to undergo the surgery, unless the case is severe. Patients suffering repeated episodes may benefit from the surgery. In such cases the risks of complications from the diverticulitis outweigh the risks of complications from surgery.
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| ==Complications== | |
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| In complicated diverticulitis, [[bacteria]] may subsequently infect the outside of the [[Colon (anatomy)|colon]] if an [[inflamed]] diverticulum bursts open. If the [[infection]] spreads to the lining of the [[abdominal cavity]], ([[peritoneum]]), this can cause a potentially fatal [[peritonitis]]. Sometimes inflamed diverticula can cause narrowing of the [[bowel]], leading to an [[obstruction]].
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| Also, the affected part of the colon could adhere to the [[Urinary bladder|bladder]] or other [[organ (anatomy)|organ]] in the [[pelvic cavity]], causing a [[fistula]], or abnormal connection between an organ and adjacent structure or organ, in this case the colon and an adjacent organ.
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| * [[Bowel obstruction]]
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| * [[Peritonitis]]
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| * [[Abscess]]
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| * [[Fistula]]
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| * [[Bleeding]]
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| * [[Stenosis|Strictures]]
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| ==References==
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| {{reflist|2}}
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| ==External links== | | ==External Links== |
| * [http://www.hmc.psu.edu/healthinfo/d/diver.htm Health and Disease Information on Diverticulitis] at [[Pennsylvania State University|Penn State University]]
| | * [http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/ Diverticulosis and Diverticulitis at National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)] |
| * [http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/ Diverticulosis and Diverticulitis] at [[National Institute of Diabetes and Digestive and Kidney Diseases|NIDDK]] | |
| * [http://www.mayoclinic.com/health/diverticulitis/DS00070 Diverticulitis] at [[Mayo Clinic]]
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| * [http://www.diverticulitis-diet.info/ Diverticulitis Diet Info] from Diverticulitis-Diet.info
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| {{SIB}}
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| {{Gastroenterology}} | | {{Gastroenterology}} |
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| [[Category:Digestive diseases]]
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| [[Category:Surgery]]
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| [[Category:Abdominal pain]]
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| [[Category:Hematology]]
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| [[Category:Gastroenterology]]
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| [[de:Divertikulitis]] | | [[de:Divertikulitis]] |
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| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
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| {{jb1}}
| | [[Category:Surgery]] |
| | [[Category:Hematology]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |