Diverticulitis - Diverticulitis Robert Zaid PGY-1 October...

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Diverticulitis Robert Zaid PGY-1 October 24, 2005 Genesys Regional Medical Center
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Barcelona - Gaudi
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Diverticulitis Outline Definition Pathophysiology Epidemiology Clinical presentation Differential Imaging Laboratory Treatment Reasons for surgery
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Diverticulitis Definition Diverticula Etiology Outpouchings Occur in areas weak and under stress – Prolapse of mucosa and submucosa may occur. Location – Arteries penetrate the muscularis to reach the submucosa and mucosa. Diverticula form through entire colon » Left colon » Sigmoid (most common) » Right sided (uncommon) http://health-pictures.com/diverticulitis-picture.htm Saunders, W., B., Wilcox, M., 2004, Elsevier imprint, Cecil’s Textbook of Medicine, Chapter 143, Online version, Diverticulitis
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Diverticulitis Definition Diverticulitis Fecalith becomes impacted in a diverticulum Erosion through the serosa Perforation Saunders, W., B., Wilcox, M., 2004, Elsevier imprint, Cecil’s Textbook of Medicine, Chapter 143, Online version, Diverticulitis
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Citadel Park
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Diverticulitis Pathophysiology Diverticula Acquired or congenital Can affect small or large intestine May be related to an increase in intramural pressure Occurs in the weakest areas of the colonic wall Adjacent to the vasa recta Mesenteric side of the colon Joffe, S, Kachulis, A., Emedicine, Online Version, 2005, Colon, diverticulitis , www.emedicine.com
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Diverticulitis Pathophysiology Theories Deficiency in dietary fiber Western diet Decreased fecal bulk Narrowing of the colon Small fecal mass » Increased intraluminal pressure needed to move material Loss of tensile strength Decrease in elasticity Proof? High fiber diet appears to decrease incidence Brunicardi, C., F., Schwartz principles of surgery, pp 1082-1084, 8 th edition, 1999
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Diverticulitis Pathophysiology Diverticula False diverticula (pulsion) Herniation through colonic wall Mucosa Muscularis Occur between tenia coli Points of weakness High intraluminal pressure Bleeding is self limiting True diverticula Rare and usuall congenital Comprise all layers of bowel wall Brunicardi, C., F., Schwartz principles of surgery, pp 1082-1084, 8 th edition, 1999
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Diverticulitis Pathophysiology Diverticulitis Inflammation in and around a diverticulum Stagnation of nonsterile inspissated fecal material (fecalith) May compromise the blood supply Cusing inflammatory erosion of the mucosal lining Perforation – Intramural abscess – Fibrinous exudate Abscess formation – Local adhesions – Peritonitis Sealed-off abscesses – Contained sinus tracts – Fistulas Joffe, S, Kachulis, A., Emedicine, Online Version, 2005, Colon, diverticulitis , www.emedicine.com
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Diverticulitis - Diverticulitis Robert Zaid PGY-1 October...

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