DIVERTICULITIS

Diverticulitis: Description:Def: Inflammation of a diverticulum, especially of the small pockets in the wall of the colon which fill with stagnant fecal material and become inflamed; rarely, they may cause obstruction, perforation, or bleeding.The function of the colon is to pass the food which is not digested out of your body. Our digestive system cannot digest all the food we eat. Especially the processed food and junk food is very difficult to digest. It is because of the absence of an important thing - FIBRE. Fibre helps to pass the stools easily.Since processed and junk food have very little or no fibre at all, the food is not easily passed through the colon. This will require pressure from your side on the colon to get rid of the stools. When you do this regularly, the colon walls become weaker and weaker. Finally some spots become so weak that they bulge out and form pouches. These are the diverticula formed on your colon wall.When a particle goes into these pouches, suddenly inflammation occurs and you will get a diverticulitis attack.Diverticulosis is very common. It is found in more than half of Americans over age 60. Only a small percentage of these people will develop the complication of diverticulitis.Diverticulitis is caused by inflammation, or (sometimes) a small tear in a diverticulum. If the tear is large, stool in the colon can spill into the abdominal cavity, causing an infection (abscess) or inflammation in the abdomen.Symptoms:DiverticulitisIdentifying diverticulitis is difficult for you if it happened for the first time. But if it is a repetitive attack then you will realize it very soon. Here are some of the symptoms of diverticulitis:
  • Pain in the lower left abdominal area.
  • Constipation (Irregular and difficult evacuation of the bowels).
  • Bloating.
  • Fever.
  • Nausea (a state that precedes vomiting).
Causes and Risk factors:Doctors aren't sure what causes diverticulitis. But they think that a low-fiber diet may play a role. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon.Diverticulitis develops when bacteria become trapped in pouches (diverticula) that have formed along the wall of the large intestine, leading to an infection. The bacteria grow and cause inflammation and pressure that may lead to a small perforation or tear in the wall of the intestine. Peritonitis, an infection of the lining of the abdominal wall, may develop if infection spills into the abdominal (peritoneal) cavity.The reason diverticula form in the wall of the large intestine (colon) is not completely understood. Doctors think diverticula form when high pressure inside the colon pushes against weak spots in the colon wall. Uncoordinated movements of the colon can also contribute to the development of diverticula.Normally, a diet with adequate fiber (also called roughage) produces stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool. A low-fiber diet also can increase the time stool remains in the bowel, adding to the high pressure. Pouches may form when the high pressure pushes against weak spots in the colon where blood vessels pass through the muscle layer of the bowel wall to supply blood to the inner wall.It is not known why some people who have these diverticula (a condition called diverticulosis) develop diverticulitis and others do not.The possibility of developing diverticulitis increases with age.You may be more likely to develop diverticulitis if you:Eat a low-fiber diet.
  • Have a family history of diverticulosis.
Diagnosis:Your doctor will take a history and give you a physical examination if diverticulitis is suspected. Depending on your symptoms, you may have one or more tests to rule out other medical problems that could be causing your symptoms. The extent of testing will depend on how bad your symptoms are and how long they have lasted.Routine tests: These tests may be done any time you see your doctor about abdominal pain or other symptoms.Complete blood count (CBC) may show if you have an infection or if you have too few red blood cells in your blood, possibly because of bleeding in the colon.
  • Urinalysis may show you have a urinary tract infection.
  • Abdominal X-ray may provide clues about the cause of abdominal pain and other symptoms.
  • The digital rectal exam looks for tenderness or a mass in the lower pelvic area.
  • The fecal occult blood test looks for blood in your stool.
  • Tests done as needed.
Depending on your symptoms, your doctor may want to do one or more of these tests.A computed tomography (CT) scan may be done if symptoms suggest you have a pocket of infection (abscess) in your abdomen or that a pouch (diverticulum) has burst. The scan also can reveal other possible causes of your symptoms.
  • A barium enema X-ray may be used to show diverticula or other possible causes of your symptoms. But a barium enema X-ray usually is not done while you are having an attack of diverticulitis because of the risk that the barium might spill into the peritoneum (the lining of the abdominal cavity) if you have a perforation. A material that performs a function similar to barium but that can dissolve in water (water-soluble contrast) may be used instead. See barium enema images of a normal colon and of diverticulosis.
  • Flexible sigmoidoscopy and colonoscopy may be used if your main symptom is bleeding from the intestine. These tests also may be done to look for narrow spots or growths in the intestine and to rule out ulcerative colitis or cancer.
  • An upper gastrointestinal (UGI) series may be done to find out whether your symptoms may be caused by a problem in your stomach or small intestine.
  • An upper gastrointestinal endoscopy may be done to find out whether your symptoms are caused by a problem in your stomach or the upper part of your small intestine.
Treatment:Initial treatment: Treatment for diverticulitis depends on the severity of your symptoms. If the pain is mild, you are able to drink liquids, and you have no signs of complications, treatment may include:Medicines such as antibiotics and pain relievers.
  • Changes in diet, starting with a clear-liquid or bland diet that is low in fiber until the pain goes away, then increasing the amount of fiber.
If the pain is severe, you are not able to drink liquids, or you have complications of diverticulitis, hospitalization is necessary.Treatment will include:Receiving antibiotics in a vein (intravenous, or IV).
  • Receiving intravenous fluids and nutrition only (no food or drink by mouth) for up to a week to allow the bowel to rest.
  • Keeping the stomach empty by sucking out the contents through a tube passed up the nose and down the throat into the stomach (nasogastric or NG tube). This may be needed if you are vomiting or have abdominal swelling.
  • Performing surgery either for complications of diverticulitis or if you have had repeated attacks that are not helped by changing your diet. Overall, fewer than 6 out of 100 people with diverticulitis need surgery.
  • Most cases of promptly treated diverticulitis will improve in 2 to 3 days.
Ongoing treatment: Treatment after recovery from an attack of diverticulitis is aimed at preventing another attack.Treatment may include:Gradually increasing the amount of fiber in the diet through fruits, vegetables, wheat bran, and possibly the regular use of a fiber supplement.
  • Getting plenty of fluids daily.
  • Having regular doctor visits to monitor your condition. If you have diverticulitis, the doctor may see you about 2 days after treatment begins to make sure you are improving. A colonoscopy or barium enema X-ray probably will be done about 6 weeks later, after symptoms are under control, to look for any other problems, such as inflammatory bowel disease or colon cancer.
Treatment if the condition gets worse: In some cases, complications of diverticulitis, such as an abscess, perforation, or bowel obstruction, can develop. Surgery to remove the affected part of the intestine usually is needed to treat these conditions.Nonurgent (elective) surgery also may be done for diverticulitis if you have had two or more severe attacks, which usually indicates a greater chance of having future attacks.4Other Treatment Include:Draining an abscess: In some cases of diverticulitis, a pocket of infection (abscess) in the abdomen heals on its own. At other times it can be drained without surgery. A needle is passed through the skin into the abscess, and the liquid containing the infection is drained. A computed tomography (CT) scan is used to help the doctor guide the needle into the abscess. Sometimes a plastic drain is placed temporarily in the abdomen to drain the abscess.Bowel rest: A blocked colon can sometimes be treated with bowel rest. You are not given anything to eat but instead receive fluids and nutrients through a tube connected to a vein. Suction through a tube placed in the nose and down into the stomach may be needed to keep the stomach emptied of digestive juices.After 2 to 3 days of bowel rest, you are given something to eat. If the obstruction has cleared up, no surgery is needed. If the obstruction remains, bowel rest may be continued. If repeated periods of bowel rest fail to clear up the obstruction, surgery to remove the diseased part of the colon may be considered.Home Remedies:There are some home remedies which you can try to prevent another diverticulitis attack. They help your digestive system by giving it the strength needed for digestion. Don't think that they will help you when you get a diverticulitis attack. They are only intended to help in the digestion and to ease your mild stomach trouble.Garlic: Garlic can be thought of as nature's gift for helping in digestion. Taking it in adequate quantity will give relief. A clove of garlic can be taken 2 to 3 times a day to help your stomach.Papaya: Papaya is the only fruit containing papain which is a natural digestive aid. It helps to clean the digestive track. You can take it in raw form or just make a juice and drink.Medicine and medications:Patients with mild symptoms abdominal pain due to muscular spasm in the area of the diverticula may benefit from anti-spasmodic drugs such as:Chlordiazepoxide (Librax).
  • Dicyclomine (Bentyl).
  • Hyoscyamine, atropine, scopolamine, phenobarb (Donnatal).
  • Hyoscyamine (Levsin).
When diverticulitis occurs, antibiotics are usually needed. Oral antibiotics are sufficient when symptoms are mild. Some examples of commonly prescribed antibiotics include:Ciprofloxacin (Cipro).
  • Metronidazole (Flagyl).
  • Cephalexin (Keflex).
  • Doxycycline (Vibramycin).
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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