Diverticulosis pathophysiology: Difference between revisions
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===Pathogenesis=== | ===Pathogenesis=== | ||
Diverticula develop at well-defined points of weakness, which correspond to where the [[vasa recta (intestines)|vasa recta]] penetrate the circular muscle layer of the colon<ref name="pmid1087123">{{cite journal |vauthors=Meyers MA, Alonso DR, Baer JW |title=Pathogenesis of massively bleeding colonic diverticulosis: new observations |journal=AJR Am J Roentgenol |volume=127 |issue=6 |pages=901–8 |year=1976 |pmid=1087123 |doi=10.2214/ajr.127.6.901 |url=}}</ref>. [[image:2015-11-02_6-30-46.jpg| | Diverticula develop at well-defined points of weakness, which correspond to where the [[vasa recta (intestines)|vasa recta]] penetrate the circular muscle layer of the colon<ref name="pmid1087123">{{cite journal |vauthors=Meyers MA, Alonso DR, Baer JW |title=Pathogenesis of massively bleeding colonic diverticulosis: new observations |journal=AJR Am J Roentgenol |volume=127 |issue=6 |pages=901–8 |year=1976 |pmid=1087123 |doi=10.2214/ajr.127.6.901 |url=}}</ref>. [[image:2015-11-02_6-30-46.jpg|288px]] | ||
Revision as of 10:09, 15 November 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D.
Overview
The most important scenario behind the formation of Diverticula is, weakness in colon wall.
Pathogenesis
Diverticula develop at well-defined points of weakness, which correspond to where the vasa recta penetrate the circular muscle layer of the colon[1]. File:2015-11-02 6-30-46.jpg
A typical colonic diverticulum is a "false" or pulsion diverticulum, in which mucosa and submucosa herniate through the muscle layer,covered only by serosa. Abnormal colonic motility is an important predisposing factor in the development diverticula. Patients with diverticulosis have exaggerated segmentation contractions in which segmental muscular contractions separate the lumen into chambers. It is hypothesized that the increase in intraluminal pressure predisposes to herniation of mucosa and submucosa.
Diverticular bleeding
As a diverticulum herniates, the penetrating vessel responsible for the wall weakness at that point becomes draped over the dome of the diverticulum, separated from the bowel lumen only by mucosa[1]Over time, the vasa recta is exposed to injury along its luminal aspect, leading to eccentric intimal thickening and thinning of the media. These changes may result in segmental weakness of the artery, predisposing to rupture into the lumen.[1]
Diverticulitis
The primary process is thought to be erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles. Inflammation and focal necrosis ensue, resulting in perforation.