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Julio Alejandro Murra-Saca MD.
Gastroenterologist, Coloproctologist
Tel : (503) 226-3131, (503) 225-3087, Celular (503) 887-2507
Email
   
Edificio Centro Scan, Colonia Médica, San Salvador, El Salvador.

 

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Notes on Cyber Gastroenterology

 

What are diverticula? A diverticulum (if there are more than one they are known as "diverticula") is a protrusion of the inner lining of the intestine through the outer muscular coat to form a small pouch with a narrow neck. The commonest site for diverticula to develop is the lower left part of the colon. The presence of diverticula is often referred to as diverticulosis.

DIVERTICULAE OF THE LARGE BOWEL HAS BEEN RECOGNIZED DISEASE OF PATIENTS OVER FIFTY BUT WITH THE MORE FREQUENT USE OF COLONOSCOPY AN INCREASING NUMBER OF CASES IN YOUNGER PATIENTS STARTING AT THIRTY-FIVE HAVE BEEN FOUND. TERMS SUCH AS DIVERTICULITIS, DIVERTICULOSIS AND DIVERTICULAR DISEASE MAY BE CONFUSING TO THE GENERAL PUBLIC AND MUST BE THOROUGHLY EXPLAINED TO PATIENTS.

 


Diverticulitis is inflammation in and around a diverticulum. The cause of diverticulitis is probably mechanical. The stagnation of nonsterile inspissated fecal material, termed a fecalith, within the diverticulum may compromise the blood supply to the thin-walled sac and render it susceptible to invasion by colonic bacteria, causing inflammatory erosion of the mucosal lining with perforation. This sequence of events can involve perforation into the colonic wall, with the formation of an intramural abscess. However, perforation usually occurs into the pericolic fat, leading to fibrinous exudate, abscess formation, local adhesions, or peritonitis. Most patients develop sealed-off abscesses or contained sinus tracts and fistulas. Fistulas usually involve adjacent structures, such as the bowel, urinary bladder, vagina, and anterior abdominal wall. Other potential complications include bowel obstruction and peritonitis.

A high-fiber diet is recommended. The American Dietetic Association recommends 20 to 35 grams of fiber each day.

DIVERTICULAR DISEASE OF THE COLON IS THE DISEASE PROCESS CAUSED BY DIVERTICULAE. THIS AILMENT HAS BEEN RELATED TO THE POOR INGESTION OF FIBER IN A PATIENTS DIET. IT IS MORE COMMON IN DEVELOPED NATIONS, BUT ITS INCIDENCE IS VERY MUCH ON THE RISE IN DEVELOPING COUNTRIES SUCH AS HERE IN EL SALVADOR, WHERE THE DIETARY HABITS ARE BEING AMERICANIZED, AS CAN BE OBSERVED BY THE INCREASING NUMBER OF INTERNATIONAL FAST FOOD CHAINS OPENING THEIR FRANCHISES. ESPECIALLY YOUNG PEOPLE PREFER MODERN FAST FOOD OVER MORE TRADITIONAL MEALS.
A diet low in fiber promotes constipation and straining at bowel movements that may worsen diverticulosis
Fortunately, most diverticula cause no symptoms and require no treatment. complications do occur and can be serious. These may include abdominal pain, rectal bleeding, and diverticulitis.
Abdominal Pain Most diverticular pouches are painless. But over time, spasms can occur and individuals may experience intermittent dull or crampy pain in the left lower abdomen. This pain is usually associated with a change in bowel habit. When diverticulosis is far advanced, the lower colon may become narrowed and distorted. When this occurs, there may be thin or pellet-shaped stools, persistent bouts of constipation, and an occasional rush of diarrhea.
Rectal Bleeding bleeding occurs from a ruptured blood vessel in one of the pouches. This may produce a gush of red blood from the rectum or maroon-colored stools. The bleeding is usually self-limited and stops on its own, but requires careful evaluation and usually a brief hospitalization. Occasionally, emergency surgery is necessary to stop the loss of blood.
Diverticulitis is a complication of diverticulosis. The colon is home to many beneficial bacteria - helpful as long as they stay within the colon. Sometimes, one of the diverticular pouches becomes thin and ruptures allowing bacteria normally contained inside the colon to seep out through the wall and cause infection on the outside of the colon. When this occurs, it is called diverticulitis. Diverticulitis can be mild with only slight discomfort in the left lower abdomen - or it can be extreme with abscess formation, severe tenderness and fever. en many cases
the patient needs an emergency surgery The surgeon opens the abdomen and removes the affected part of the colon. The remaining sections of the colon are rejoined. This type of surgery, called colon resection, aims to keep attacks from coming back and to prevent complications. The doctor may also recommend surgery for complications of a fistula or intestinal obstruction.

Mortality/Morbidity: Mortality and morbidity are related to complications of diverticulosis, which are mainly diverticulitis and lower GI bleeding. These occur in 10-20% of patients with diverticulosis during their lifetime.

History:
Clinical historical features of inflammatory disease include the following:
Abdominal pain - Occurs mostly in the left lower quadrant and tends to be steady, severe, and deep
History of fever suggestive of diverticulitis
Previous episodes of dull, colicky, and diffuse abdominal pain accompanied with flatulence, distention, and change in bowel habits (diverticulosis)
Altered bowel habits including diarrhea, increased constipation, and tenesmus (physician may note obstipation when treating a complicating bowel obstruction)
Nausea and vomiting
Dysuria, pyuria, and urinary frequency if bladder or ureter are irritated
History of pneumaturia or recurrent urinary tract infections (colovesicular fistulas)
Feculent vaginal discharge (fistulas with the uterus or vagina)
Severe and generalized abdominal pain (diffuse peritonitis)
Back or lower extremity pain (perforation)
Establish history of hemorrhagic disease, including the following:
Lower GI bleeding from diverticulosis occurs in the form of bright red-colored or wine-colored stools.
Onset of bleeding typically is sudden, painless, and accompanied by an urge to defecate.
Amount of bleeding typically is massive and tends to stop spontaneously.
Ascertain a previous history of gastric or duodenal ulcers, liver disease, or GI bleeding.
Discomfort and pain upon defecation indicate hemorrhoids or anal fissures.
History of weight loss and mucus in the stools indicates inflammatory bowel disease.
Establish list of medications used (nonsteroidal anti-inflammatory drugs [NSAIDs], steroids) and of alcohol abuse.
Establish bleeding tendencies.

 

Sex: Male-to-female ratio is equal.


Please click on the image to download the video clip, to appreciate in full screen press Alt and Enter on the windows media and  wait to be complete the download.
Endoscopic Image of diverticulae, It observed some holes that are the diverticulae, Please click on the image to download the video clip, wait to complete the download and press Alt and Enter to be apreciated in full screen.


Endoscopic Image of diverticula with a peri-diverticular fibrinoide exudade
which means that are diverticulitis.

Please click on the image to download the video clip, to appreciate in full screen press Alt and Enter on the windows media and  wait to be complete the download.
Endoscopic image of a diverticula that which emerges dark blood, It caused
rectal hemorrhage.

Please click on the image to download the video clip, to appreciate in full screen press Alt and Enter on the windows media and  wait to be complete the download.
Same diverticula as above, A close out it observed a blood clot
in the diverticula hole.

For m,ore endoscopic details download the video clip by clicking on the endoscopic image.
Same case as above.
For more endoscopic details download the video clip by clicking on the endoscopic image

Muscular hypertrofia due to diverticular disease redness is observed Scattered Patches of dark erythematous mucosa
are displayed in the image, however Small red fold in diverticular disease are common and
related to strong muscular contractions associated with the high pressure segment in the sigmoid.

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