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What is diverticulitis? Causes, symptoms, treatment & more

So, I think the important thing is to understand
there’s diverticulosis, which are the presence of little sack like protrusions in the bowel,
in the large intestine, and if they get inflamed, this is then called diverticulitis. If you
have diverticulosis, which about 50% of those over the age of 60 have, you may not feel
any symptoms, you may not know you have it. However, if you have diverticulitis, you’ll
know because you have abdominal pain, you may have a low-grade temperature, nausea,
vomiting, you’ll generally feel unwell and that’s the time to consult your doctor. So diverticulosis is simply the presence of
these sack like protrusions in the large intestine through the colon, and 50% over the age of
60 will have them especially in the Western world, but we are seeing an increasing proportion
of younger people with diverticulosis. We’re not really sure what causes it. But we do
think that a diet low in fibre somehow alters the colonic motility creating increased pressure
within parts of the bowel such as the left side of the bowel, the sigmoid colon. With
this increased pressure, there are weak parts of the colon wall, especially where the blood
vessels come in, and you can get little pouches which protrudes to the outside of the lumen
of the bowel wall. Interestingly, the Asians seem to have a far increased risk of right
sided, that’s right, colonic diverticulosis, whereas in the West, we see left sided predominance.
We’re not really sure why that is that difference. So diverticulitis is the acute inflammation
of the diverticular. These little sacks in the large intestine, and what causes the actual
inflammation we’re not quite sure, but there are two theories. One is that of damage, perhaps
due to hard stool or food residue at the neck of the diverticulum, the sack that leads to
inflammation and maybe a micro perforation, little tear with collection of bacteria. But
the other thought is, and this is not mutually exclusive, is that there’s damage to the blood
vessels at the neck of that sack, and some kind of reduction in the blood flow then leads
to bacterial proliferation. And again, micro perforation leading to the clinical symptoms,
which include abdominal pain, nausea, perhaps vomiting, and the low-grade temperature. So, it’s common sense really, when you’ve
got an acute inflammation, you’re generally not feeling well, you may not have an appetite.
In an acute diverticulitis, when you really may need to see a doctor, you should immediately
go to a low residue diet: clear liquids, broths, and that may be the treatment for a lot of
people with acute uncomplicated diverticulitis. In the past, we used to hospitalise all these
people and they were given intravenous antibiotics. And indeed, some may still need that. However,
there are a lot of people with this acute, uncomplicated diverticulitis, that could be
managed at home without antibiotics on a liquid diet for 72 hours with paracetamol to ease
the pain and oftentimes they will not need further antibiotics. There have been recent
studies looking into different ways to manage acute diverticulitis, especially when uncomplicated,
and we found that we’re reducing hospitalizations, and there’s absolutely no risk to doing that.
But the important factor is that you see a doctor or go to the A&E because if you have complicated disease, you will need to be admitted and you will need intravenous
antibiotics. The important factor is that the symptoms of acute diverticulitis can mimic
that of many other diseases such as irritable bowel syndrome or bowel cancer, and most people
who have had an episode of acute diverticulitis will need a colonoscopy: a camera examination
of the bowel eight weeks after their acute flare just to make sure there’s nothing else
underlying. So the symptoms of diverticulitis can vary.
They do include lower abdominal pain, especially on the left side, but maybe anywhere. Low
grade temperature, general malaise and can be associated with nausea, vomiting, reduced
appetite, but also there are urinary symptoms. For instance, if there’s inflammation near
the bladder, you might feel that you have a urinary tract infection or need to pass
urine even more. If you’re worried about any of this, it’s important to seek medical advice
because this may be a more significant disease process. If it is acute diverticulitis, you
may be referred to accident and emergency. You may see your GP and he may manage you
to depending on how he feels you are on your clinical examination. But clinically you can
diagnose it. Oftentimes if you’re in A&E, we will obtain the CT scan for imaging to
actually see if there’s any complications of diverticulitis. Although complications
are rare, less common, they include things like abscess formation, which is a localised
piece of infection. You can get perforation, which is a tear in the lining of the bowel,
you can get peritonitis, which is widespread inflammatory change, which can be life threatening.
Few percent of people can bleed but this is not common with acute diverticulitis, and
chronically you may get changes also. So, it’s important that you seek advice. So acute diverticulitis, that’s when you acutely
become unwell with inflammation of one of these sacks or diverticular. And you can have
complicated or uncomplicated diverticulitis. If it’s uncomplicated, you may generally be
feeling a bit under the weather. And we can treat that with 72 hours of a liquid diet
with paracetamol to alleviate the temperature and the pain. If however, there are complications;
if the temperature is very high, or if you’re older and you have other diseases such as
you’re taking steroids, you’re on chemotherapy, you have diabetes, then you’re likely to be
admitted to the hospital. And again, it’ll be a liquid diet and perhaps some intravenous
antibiotics so that we can get to the root of the infection much, much quicker.

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