Diverticular disease a4medicine.co.uk escoliosis dorsal de convexidad derecha

Protrusion occurs in weak areas of the bowel through which blood vessels can penetrate ( see figure ) diverticula generally are multiple typically 5-10 mm in dia but can occasionally be up to 20 mm most common site is sigmoid colon ( 90 % ) , although can happen throughout the large bowel can also happen on right side result possibly from complex interaction of colon structure , intestinal motility , diet and genetic features

Most frequent finding in colonoscopies done to r/o cancer frequent in western countries – affecting escoliosis lumbar de convexidad izquierda up to 50-66 % individuals aged > 80 prevalence is increasing worldwide ( ↑↑es with urbanization ) increases with age ( uncommon 50 yrs western diet ( for eg diet high in red meat and total fat content ) obesity nsaids use no current link identified with smoking , caffeine and alcohol consumption genetics- rare syndromes demonstrate a strong predisposition of colonic diverticula .

Examples include
○ marfans syndrome
○ ehlers-danlos syndrome
○ polycystic dolor lumbar cronico kidney disease ( PKD )

Diverticular disease- also defined by terms as symptomatic diverticula symptomatic diverticular disease symptomatic uncomplicated diverticular disease ( SUDDP ) intermittent abdominal pain – left lower quadrant pain may be triggered by eating constipation , diarrhoea or occasionally large PR bleed bloating presentation may be similar to irritable bowel syndrome tender LLQ on palpation

Refer if suspected investigations ○ colonoscopy
○ CT give advise on
○ diet-healthy balanced diet
○ fibre intake up to 30 gm/day consider a bulk forming laxative if
○ unable to take high fibre diet
○ symptoms of diarrhoea / constipation persist analgesia ○ prn paracetamol
○ CKS advises caution with the use of NSAIDS
codeine.Consider a follow up in 1 month based on clinical judgement

Diverticulitis- about 4 to 5% of patients with hernia discal lumbar sintomas colonic diverticula develop acute diverticulitis diverticulitis represents a spectrum of inflammatory changes which can range from
○ subclinical local inflammation
○ generalized peritonitis with free perforation underlying process is thought to be a micro or macro perforation of a diverticulum due to
○ increased intraluminal pressure
○ inspissated food particles
○ thickened fecal material ( as in appendicitis ) in the neck of diverticulum.

Manage in primary care – mild , uncomplicated case consider antibiotics 7-14 days if infection suspected
○ augmentin
○ metronidazole
○ ciprofloxacin watchful waiting if
○ no infection suspected
○ no comorbidities
○ systemically well check bloods for contractura lumbar sintomas ↑ WCC, CRP advice clear liquids for 2-3 days with reintroduction of solids if symptoms improve

Complications- complete bowel obstruction due to diverticular disease is relatively rare
partial obstruction is more common intra-abdominal abscess -mass on O/E or peri-rectal fullness on DRE perforation ( free perforation ) uncommon
more likely if immunocompromised associated with high mortality rate fistulas- occur in 2 % of patients with dolor lumbar embarazo primer trimestre divertiucular disease
↑↑ frequent in men ( mostly colovesical ) bleeding – approximately 15 % of people with diverticula will develop bleeding from the bowel wall
usually abrupt , painless and large in volume

References- references commissioning guide : colonic diverticular disease royal college of surgeons ( RCS ) march 2014 world gastroenterology organisation practice guidelines diverticular disease dr T murphy et al diverticular disease : diagnosis and treatment holly salzman et al american family physician oct 2005 vol 72 , number 7 REVIEW treatment of diverticular disease : an update on latest evidence and clinical implications carobotti M, annibale B. Drugs in context 2018 ; 7:212526 BMJ best practice diverticular disease böhm SK. Risk factors for diverticulosis, diverticulitis, diverticular perforation, and bleeding: A plea for more subtle history taking. Viszeralmedizin. 2015;31(2):84-94. Sartelli M, catena F, ansaloni L, et al. WSES guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J emerg surg. 2016;11:37. Published 2016 jul 29. Doi:10.1186 hernia de disco lumbar ejercicios/s13017-016-0095-0 diverticular disease- CKS NHS

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