, for ova, parasites, bacteria, and blood to rule out infection • barium enema may reveal colon spasm and tubular appearance of descending colon without evidence of cancers and diverticulosis • Lactose intolerance test rules out lactose intolerance (celiac disease) • Sigmoidoscopy or colonoscopy may reveal spastic contractions without evidence of colon cancer or inflammatory bowel disease • Rectal biopsy rules out malignancy.
5. Diverticular Disease and Hemorrhoids • Diverticular Disease • Anywhere, from the proximal end of the pharynx to the anus – Diverticulosis – Diverticulitis – Diverticular Hemorrhage • Hemorrhoids – Classification
• Diverticula – an abnormal pouch or sac opening from a hollow organ (as the colon or bladder) • Diverticulosis - the presence of diverticula in the colon • Diverticulitis - inflammation or infection of a diverticulum of the colon • Diverticular Disease - a disorder characterized by diverticulosis or diverticulitis
• Common, affects men and women equally • Risk increase with age • Environmental and lifestyle factors may play a role in the development of the disease • Most common in left colon (70-90%)
Pathophysiology of Diverticula • Associations with diets low in dietary fiber and high in refined carbohydrates. – Less bulky stools that retain less water and may alter gastrointestinal transit time; – Increase intracolonic pressure and make evacuation of the colonic contents more difficult. • Other factors: – physical inactivity, – constipation, – obesity, – smoking, – and treatment with nonsteroidal antiinflammatory drugs.
Diverticular disease in developed countries is blamed largely on a low fiber diet.
Diverticular Disease Signs and symptoms 1. Acute Diverticulitis a. Acute mild diverticulitis : moderate lower quadrant pain, low fever, and leukocytosis b . Acute severe diverticulitis : • Left lower quadrant pain • High fever, chills, hypotension from sepsis , • Shock from the release of fecal material from the rupture site • Abdominal rigidity from the rupture of diverticula , abscesses, and peritonitis • microscopic or massive haemorrhage from rupture of diverticula near a vessel
2. Chronic diverticulitis • intestinal obstruction manifested by: • Constipation , ribbonlike stools, • intermittent diarrhoea , • and abdominal distention • Abdominal rigidity and pain , • Diminishing or absent bowel sounds • Nausea, and vomiting secondary to intestinal obstruction .
Complications • Abscess • Peritonitis • Obstruction • Fistula formation: connection between different organs • Hemorrhage Helpful tests • barium enema reveals filling diverticula • biopsy to rule out malignancy • blood studies, elevated ESR
• Xray – Free air, perforation • CT scan Colonoscopy and sigmoidoscopy • are typically avoided when acute diverticulitis is suspected because of the risk of perforation.
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- Fall '19