Diverticulitis means inflammation of multiple diverticula or a single diverticulum. It is most frequently a disease of the colon. A diverticulum is a sac-like outpouching of a hollow structure. In diverticulitis, the outpouching becomes inflamed, generally from infection. The formation of diveriticula and subsequent inflammation is associated with certain risk factors and requires prompt diagnosis and management, which should be done with the consultation of a licensed healthcare professional. Pathology is the study of disease and involves the causes and mechanisms of the development of a disease, risk factors, diagnosis, treatment, complications, prevention and treatment.
Pathogenesis of Diverticula
Diverticula in the colon may be caused by increased pressure inside the colon that presses outward on the walls. Areas where blood vessels enter the walls of the colon are points of weakness and more likely to be points where diverticula form. The increased pressure, combined with decreased strength of connective tissue causes parts of the wall to bulge out. This is a condition called diverticulosis that usually does not cause symptoms.
Pathogenesis of Diverticulitis
Once diverticulosis occurs, these outpouchings can become blocked, inflamed and infected, which is the condition known as diverticulitis. The colon contains many bacteria that can infect the diverticula.
Diet and Risk Factors
Some risk factors may lead to diverticulosis and diverticulitis. One of the most well-established risk factors is age, with the prevalence increasing after age 40. Connective tissue disorders also contribute to a weak colon wall and can predispose a person to diverticulosis. Constipation is another risk factor, and this condition can be worsened or improved by diet. Low-fiber diets may contribute to the development of the disease as can diets high in meat, particularly red meat. Popcorn, corn, nuts and seeds were thought to contribute to diverticulitis by plugging diverticula and allowing bacteria to grow, but studies, including one in the "Journal of the American Medical Society" in 2008, indicate that they are safe.
Diagnosis and Complications
The diagnosis of diverticulitis coincides with a history of diverticulosis, but such a diagnosis may not be present because most cases are silent. Diverticulitis often causes pain in the left-lower area of the abdomen and fever. A blood test shows high white cells, which is a marker of inflammation and infection. Nausea, vomiting and changes in bowel habits also can occur. A computed axial tomography, or CT or CAT, scan is generally the next step to establish the diagnosis.
Prevention and Treatment
According to Mayo Clinic, preventing the pathological development of diverticulitis involves diet and exercise. It recommends drinking plenty of fluids, eating high fiber, responding to bowel urges and exercising regularly. Treatment involves intravenous fluids and antibiotics. If complications occur, the diverticulitis is recurrent or the infection does not clear, a person may need surgery to remove the diseased part of the colon.
References
- "Harrison's Principles of Internal Medicine"; Anthony S Fauci, et al.; 17th Ed., 2008
- "Robbins and Cotran Pathologic Basis of Disease"; Vinay Kumar, et al.; 8th Ed., 2009
- "Journal of the American Medical Association"; "Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease". Lisa L. Strate, M.D., M.P.H., et al.; 2008
- MayoClinic.com: Diverticulitis: Lifestyle and Home Remedies
