Diverticular ulcer disease Flashcards
Definition
Diverticular ulcer disease, also known as diverticulitis, is a condition characterised by the inflammation or infection of small pouches called diverticula that form along the lining of the colon
There is thickening of the muscle layer, and, because of high intraluminal pressures, pouches of mucosa extrude through the muscular wall through weakened areas near blood vessels to form diverticular.
Diverticular = medical term used to describe the small bulges that stick out the side of the colon.
Diverticula are most frequent in the sigmoid but can be present throughout the whole colon.
Diverticulosis = indicates the presence of diverticula
Diverticulitis = implies that these diverticula are inflamed
Diverticular colitis = refers to crescentic inflammation of the folds in areas of diverticulosis
Aetiology/ causes
Precise mechanism of diverticula formation is not known.
Diverticulitis occurs when faeces obstruct the neck of the diverticulum, causing stagnation and allowing bacteria to multiply and produce inflammation.
Risk factors
Increasing age (leads to hypersensitivity and increased uncoordinated muscular contraction).
Low fibre diet
Epidemiology/ Population affected
Rare in rural Africa
Related to low fibre diet eaten in developed countries.
Occur in 50% of patients over the age of 50 years.
Clinical presentation
Asymptomatic in 95% of cases and usually discovered incidentally on colonoscopy or barium enema examination.
Symptomatic patients:
Intermittent left iliac fossa pain or discomfort
Erratic bowel habit (difficult to differentiate from IBS)
In severe disease – luminal narrowing results in severe pain and constipation
Prognosis
Management of uncomplicated symptomatic disease is with a well-balanced fibre diet, with smooth muscle relaxants if required.
DDX
Appendicitis
Inflammatory bowel disease
Colon cancer
Cystitis
Endometritis
Must also be differentiated from diseases causing peritonitis
