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==Overview== | ==Overview== | ||
Diverticula is a protrusion of the intestinal layers consist of [[mucosa]] and [[serosa]]. It occurs mainly in the left side more than the right side. Diverticulitis is the inflammation of this protrusion. The first step in the pathogenesis of diverticulitis is the increase of the intraluminal pressure, change of the intestinal motility and the bacterial colonization. The inflammation is caused by histamine, tumor necrosis factor and metalloproteinases which were found in diverticulitis patients tissue biopsies. Obstruction of the diverticula leads to bacteria colonization which leads to inflammation by the end. | Diverticula is a protrusion of the [[intestinal]] layers consist of [[mucosa]] and [[serosa]]. It occurs mainly in the left side more than the right side. Diverticulitis is the [[inflammation]] of this protrusion. The first step in the pathogenesis of diverticulitis is the increase of the [[intraluminal]] pressure, change of the [[intestinal]] motility and the [[bacterial]] colonization. The inflammation is caused by [[histamine]], [[tumor necrosis factor]] and [[Metalloproteinase|metalloproteinases]] which were found in diverticulitis patients [[tissue]] [[biopsies]]. [[Obstruction]] of the diverticula leads to bacteria colonization which leads to [[inflammation]] by the end. | ||
== Pathophysiology == | == Pathophysiology == | ||
===Pathogenesis=== | ===Pathogenesis=== | ||
The primary process is thought to be an erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles. | The primary process is thought to be an erosion of the diverticular wall by increased [[intraluminal]] pressure or inspissated food particles. | ||
* Diverticula is a protrusion of the intestinal layers consist of mucosa and serosa. It occurs mainly in the left side more than the right side. Diverticulitis is the inflammation of this protrusion. | * Diverticula is a protrusion of the intestinal layers consist of mucosa and serosa. It occurs mainly in the left side more than the right side. Diverticulitis is the [[inflammation]] of this protrusion. | ||
*Inflammation and focal [[necrosis]] ensue, resulting in perforation and [[inflammation]].<ref name="pmid2651018">{{cite journal |vauthors=Rege RV, Nahrwold DL |title=Diverticular disease |journal=Curr Probl Surg |volume=26 |issue=3 |pages=133–89 |year=1989 |pmid=2651018 |doi= |url=}}</ref> | *Inflammation and focal [[necrosis]] ensue, resulting in [[perforation]] and [[inflammation]].<ref name="pmid2651018">{{cite journal |vauthors=Rege RV, Nahrwold DL |title=Diverticular disease |journal=Curr Probl Surg |volume=26 |issue=3 |pages=133–89 |year=1989 |pmid=2651018 |doi= |url=}}</ref> | ||
*Pathogenesis of diverticulitis includes three main processes which are: | *Pathogenesis of diverticulitis includes three main processes which are: | ||
**Change of the intestinal motility | **Change of the [[intestinal]] motility | ||
**Increase of the luminal pressure | **Increase of the [[luminal]] pressure | ||
**Colonic microenviroment disorder which leads to infection after that.<ref name="pmid24430321">{{cite journal| author=Morris AM, Regenbogen SE, Hardiman KM, Hendren S| title=Sigmoid diverticulitis: a systematic review. | journal=JAMA | year= 2014 | volume= 311 | issue= 3 | pages= 287-97 | pmid=24430321 | doi=10.1001/jama.2013.282025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24430321 }} </ref> | **Colonic microenviroment disorder which leads to [[infection]] after that.<ref name="pmid24430321">{{cite journal| author=Morris AM, Regenbogen SE, Hardiman KM, Hendren S| title=Sigmoid diverticulitis: a systematic review. | journal=JAMA | year= 2014 | volume= 311 | issue= 3 | pages= 287-97 | pmid=24430321 | doi=10.1001/jama.2013.282025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24430321 }} </ref> | ||
*In a vivo test of diverticulitis patient colonic tissue with chemicals added, it was overt that there is neuro-alteration to the tissue. It showed increase contractility and loss of relaxation.<ref name="pmid16423891">{{cite journal| author=Guagnini F, Valenti M, Mukenge S, Matias I, Bianchetti A, Di Palo S et al.| title=Neural contractions in colonic strips from patients with diverticular disease: role of endocannabinoids and substance P. | journal=Gut | year= 2006 | volume= 55 | issue= 7 | pages= 946-53 | pmid=16423891 | doi=10.1136/gut.2005.076372 | pmc=1856307 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16423891 }} </ref>This alteration in the muscle tissue due to the inflammation which leads to histological changes of the muscle and nerves. | *In a vivo test of diverticulitis patient colonic [[tissue]] with [[chemicals]] added, it was overt that there is neuro-alteration to the tissue. It showed increase [[contractility]] and loss of [[relaxation]].<ref name="pmid16423891">{{cite journal| author=Guagnini F, Valenti M, Mukenge S, Matias I, Bianchetti A, Di Palo S et al.| title=Neural contractions in colonic strips from patients with diverticular disease: role of endocannabinoids and substance P. | journal=Gut | year= 2006 | volume= 55 | issue= 7 | pages= 946-53 | pmid=16423891 | doi=10.1136/gut.2005.076372 | pmc=1856307 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16423891 }} </ref>This alteration in the [[muscle tissue]] due to the [[inflammation]] which leads to [[histological]] changes of the [[muscle]] and [[nerves]]. | ||
*The mechanism of the inflammation in cases of diverticulitis is known to be caused by histamine, tumor necrosis factor and matrix metalloproteinases. These substances was detected in the colonic tissue biopsies in diverticulitis patients.<ref name="pmid22680042">{{cite journal| author=Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R et al.| title=Mucosal expression of basic fibroblastic growth factor, Syndecan 1 and tumor necrosis factor-alpha in diverticular disease of the colon: a case-control study. | journal=Neurogastroenterol Motil | year= 2012 | volume= 24 | issue= 9 | pages= 836-e396 | pmid=22680042 | doi=10.1111/j.1365-2982.2012.01946.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22680042 }} </ref> | *The mechanism of the [[inflammation]] in cases of diverticulitis is known to be caused by [[histamine]], [[tumor necrosis factor]] and matrix [[metalloproteinases]]. These substances was detected in the colonic [[tissue]] biopsies in diverticulitis patients.<ref name="pmid22680042">{{cite journal| author=Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R et al.| title=Mucosal expression of basic fibroblastic growth factor, Syndecan 1 and tumor necrosis factor-alpha in diverticular disease of the colon: a case-control study. | journal=Neurogastroenterol Motil | year= 2012 | volume= 24 | issue= 9 | pages= 836-e396 | pmid=22680042 | doi=10.1111/j.1365-2982.2012.01946.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22680042 }} </ref> | ||
*Collection of feces and undigested food in the diverticula leads to diverticulum obstruction. This obstruction and by increasing the intraluminal pressure leads to diverticulum distension and collection of the bacteria that ends up into inflammation. | *Collection of [[feces]] and undigested food in the diverticula leads to [[diverticulum]] [[obstruction]]. This obstruction and by increasing the intraluminal pressure leads to diverticulum [[distension]] and collection of the [[bacteria]] that ends up into [[inflammation]]. | ||
*Presence of lymphocytes and granulomas are more predictable of chronic inflammation. | *Presence of [[lymphocytes]] and [[granulomas]] are more predictable of [[chronic inflammation]]. | ||
===Gross pathology=== | ===Gross pathology=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Diverticula is a protrusion of the intestinal layers consist of mucosa and serosa. It occurs mainly in the left side more than the right side. Diverticulitis is the inflammation of this protrusion. The first step in the pathogenesis of diverticulitis is the increase of the intraluminal pressure, change of the intestinal motility and the bacterial colonization. The inflammation is caused by histamine, tumor necrosis factor and metalloproteinases which were found in diverticulitis patients tissue biopsies. Obstruction of the diverticula leads to bacteria colonization which leads to inflammation by the end.
Pathophysiology
Pathogenesis
The primary process is thought to be an erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles.
- Diverticula is a protrusion of the intestinal layers consist of mucosa and serosa. It occurs mainly in the left side more than the right side. Diverticulitis is the inflammation of this protrusion.
- Inflammation and focal necrosis ensue, resulting in perforation and inflammation.[1]
- Pathogenesis of diverticulitis includes three main processes which are:
- Change of the intestinal motility
- Increase of the luminal pressure
- Colonic microenviroment disorder which leads to infection after that.[2]
- In a vivo test of diverticulitis patient colonic tissue with chemicals added, it was overt that there is neuro-alteration to the tissue. It showed increase contractility and loss of relaxation.[3]This alteration in the muscle tissue due to the inflammation which leads to histological changes of the muscle and nerves.
- The mechanism of the inflammation in cases of diverticulitis is known to be caused by histamine, tumor necrosis factor and matrix metalloproteinases. These substances was detected in the colonic tissue biopsies in diverticulitis patients.[4]
- Collection of feces and undigested food in the diverticula leads to diverticulum obstruction. This obstruction and by increasing the intraluminal pressure leads to diverticulum distension and collection of the bacteria that ends up into inflammation.
- Presence of lymphocytes and granulomas are more predictable of chronic inflammation.
Gross pathology
Histopathological Findings
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References
- ↑ Rege RV, Nahrwold DL (1989). "Diverticular disease". Curr Probl Surg. 26 (3): 133–89. PMID 2651018.
- ↑ Morris AM, Regenbogen SE, Hardiman KM, Hendren S (2014). "Sigmoid diverticulitis: a systematic review". JAMA. 311 (3): 287–97. doi:10.1001/jama.2013.282025. PMID 24430321.
- ↑ Guagnini F, Valenti M, Mukenge S, Matias I, Bianchetti A, Di Palo S; et al. (2006). "Neural contractions in colonic strips from patients with diverticular disease: role of endocannabinoids and substance P." Gut. 55 (7): 946–53. doi:10.1136/gut.2005.076372. PMC 1856307. PMID 16423891.
- ↑ Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R; et al. (2012). "Mucosal expression of basic fibroblastic growth factor, Syndecan 1 and tumor necrosis factor-alpha in diverticular disease of the colon: a case-control study". Neurogastroenterol Motil. 24 (9): 836-e396. doi:10.1111/j.1365-2982.2012.01946.x. PMID 22680042.