Diverticulitis pathophysiology
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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
Pathophysiology
Pathogenesis
The primary process is thought to be an erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles.
- Inflammation and focal necrosis ensue, resulting in perforation and inflammation.[1]
- 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.
- Pathogenesis of diverticulitis includes three main processes which are change of the intestinal motility, increase of the lumenal pressure, and 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
A picture shows a sigmoid colon with some diverticula:
Histopathological Findings: Actinomycosis diverticulitis & abscess
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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.