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  • • Diverticula are more common in the colon than in any other portion of the GI tract

    • Diverticulosis: the presence of multiple false diverticula

    • Colonic diverticula are acquired and are classified as false because they consist of mucosa and submucosa that have herniated through the muscular coats

    • Colonic diverticula are pulsion (rather than traction) diverticula because they are pushed out by intraluminal pressure

    • They vary from a few millimeters to several centimeters in diameter; the necks may be narrow or wide; and some contain inspissated fecal matter

    • Cultural factors, especially diet, play an important etiologic role

    • -Chief among the dietary influences is the fiber content of foods.

    • The pathogenesis of diverticula requires defects in the colonic wall and increased pressure in the lumen relative to the serosal surface

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Epidemiology

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  • • 95% of patients with diverticula have involvement of the sigmoid colon

    • Descending > transverse > ascending

    • Solitary cecal and multiple right colonic diverticula seen in Asian people

    • In Western countries, diverticula develops in perhaps 50% of persons; 10% by age 40 and 65% by age 80

    • Diverticular disease is more common in Western nations than in Japan or in developing countries of the tropics

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Symptoms and Signs

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  • • Diverticulosis probably remains asymptomatic in about 80% of people and is detected incidentally on barium enema x-rays or endoscopy if it is discovered at all

    • May present with lower GI bleeding

    • Episodic pain, constipation, diarrhea

    • Left lower quadrant tenderness

    • Left colon is sometimes palpable as a firm tubular structure

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Laboratory Findings

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  • • Normal WBC count in uncomplicated cases

    • Leukocytosis, anemia in complicated cases

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Imaging Findings

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  • Barium enema

    • -Diverticula

      -Segmental spasm

      -Muscular thickening that may narrow lumen

      -Saw-toothed appearance

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  • • Diverticulitis

    • Neoplasm (colonic, anal)

    • AV malformation

    • Hemorrhoids

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Rule Out

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  • • Neoplasm

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  • • History and physical exam

    • Digital rectal exam

    • Lower endoscopy

    • -Colonoscopy

      -Flexible sigmoidoscopy

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When to Admit

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  • • Abdominal pain

    • GI bleeding

    • Inability to distinguish diverticular disease from neoplasm

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  • • Asymptomatic persons with diverticulosis may be given a high-fiber diet

    • Symptomatic patients also can be treated with a high-fiber diet

    • Analgesics should be avoided, but if pain relief is necessary, nonopioid medications are preferred

    • Education, reassurance, and a strong relationship between physician and patient are important to successful management

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Surgery

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Indications

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  • • Massive hemorrhage or to rule out carcinoma in some patients

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Contraindications

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  • • Colon resection for uncomplicated diverticular disease or irritable bowel syndrome is rarely necessary or advisable

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Medications

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  • • Dietary fiber

    • Bulking agents (psyllium seed or hemicellulose products)

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