Diverticular disease
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Diverticular Disease. Diverticulosis , Diverticulitis, Meckel’s , Zenker’s. Diverticulum. Defintion Blind pouch protruding from alimentary tract that communicates with the gut lumen Most are ‘false’ Often found in sigmoid colon, can occur throughout colon

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Diverticular Disease

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Diverticular Disease

Diverticulosis, Diverticulitis, Meckel’s, Zenker’s


Diverticulum

  • Defintion

    • Blind pouch protruding from alimentary tract that communicates with the gut lumen

    • Most are ‘false’

    • Often found in sigmoid colon, can occur throughout colon

  • ‘True’: all 3 gut wall layers outpouch

  • ‘False’: or ‘pseudodiverticulum’ where only mucosa and submucosaoutpouch, muscularisexterna is attenuated or non existent.


Epidemiology

  • More common in developed countries

    • Food contains less fiber more refined carbohydrates

  • Diverticular disease (DD) less common before 40 years of age

  • >60% of people over 50 years in the US

  • Approximately 10%-25% of people with DD develop diverticulitis


Diverticulosis

  • Definition: Many diverticula

  • Caused by ↑intraluminal pressure and focal weakness in colonic wall

  • Associated with low fiber diets

  • Most often found in sigmoid colon

    • (highest intraluminal pressure!)

  • Often asymptomatic

  • Or associated with vague discomfort and/or painless rectal bleeding


The extent to which abnormal motility and hereditary factors contribute to diverticular disease is unknown.

Over time, the colon must work against greater pressures to move small, hard stools, develops hypertrophy, thickening, rigidity, and fibrosis.


Fig-- Diverticula of the sigmoid colon


Fig– Extensive diverticulosis in 77 year old female.


Diverticulitis

  • Inflammation or rupture of the diverticula

  • Classical symptoms: Lower left quadrant (LLQ) pain, fever, leukocytosis

  • Other symptoms: bright red rectal bleeding, colovesical fistula (fistula with bladder)  pneumaturia

  • May perforate  peritonitis, abscess formation or bowel stensois

  • Treatment: Antibiotics


Meckel’sDiverticulum

  • Most common congential anomaly of GI tract

  • True diverticulum (3 layers outpouch)

  • Persistence of vitelline duct or yolk stalk

  • May contain ectopic acid

    • Secreting gastric mucosa and/or pancreatic tissue

  • Dx: Pertechnetate(the marker injected into the body looking for ectopic gastric tissue . This is known as a "Meckel's Scan”)

  • Can cause bleeding, intussusception, volvulus or obstruction near the terminal ileum

  • Tx: Surgical, removal of diverticulum. Complications: resection of adjacent segments


Meckel’sDiverticulum

The Five 2’s:

  • 2 inches long

  • 2 feet form ileocecalvalve

  • 2% of population

  • 2 years of life, common presentation

  • 2 types of epithelia (gastric/pancreatic)


Fig. —2-year-old girl with Meckel'sdiverticulum. Shows nuclear medicine 99mTc pertechnetate scan of child with abnormal tracer uptake in mid abdomen, just to right of midline (arrow), that was later shown at surgery to be hemorrhagic Meckel'sdiverticulum.


Zenker’sDiverticulum

  • False diverticulum

  • Herniation of mucosal tissue at the junction of pharynx and esophagus

  • Symptoms: halitosis (due to trapped food), dysphagia, obstruction

  • Dx: Barium swallow. Endoscopy should not be performed due to the risk of perforating the diverticulum.

  • Tx: none for asymptomatic, surgical resection. Recently, endoscopic stapling


Fig– Barium swallow revealing Zenker’sdiverticulum


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