Natural Remedies for Curing Diverticulosis

Managing Diverticular Disease

Managing Diverticular Disease

Stop The Pain. Manage Your Diverticular Disease And Live A Pain Free Life. No Pain, No Fear, Full Control Normal Life Again. Diverticular Disease can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.

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New Diverticulitis Breakthrough Ebook Summary

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Treatment of Diverticular Disease Bleeding

Management of acute lower GI bleeding from diverticular disease should start with resuscitation of the patient followed by identification of the bleeding site. Most patients either stop bleeding spontaneously, or respond to medical or less invasive measures. However, almost a quarter of these patients will require surgical intervention for treatment of their disease.

Diverticulosis

Diverticulosis is a common colonic condition in elderly patients of the Western world, with a prevalence of 37 to 45 . Although diverticula more commonly occur on the left side of the colon, bleeding usually originates from right-sided lesions. It is estimated that hemorrhage occurs in 3 to 5 of all patients with diverticulosis. Due to the high prevalence in the general population, and particularly the elderly, it is the most common cause of lower GI bleeding, accounting for over 30 of cases. Diverticular bleeding usually presents as painless, large-volume hematochezia of abrupt onset bleeding ceases spontaneously in up to 90 of patients. Rebleeding occurs 22 to 38 of the time, and the likelihood of a third bleeding episode in such Diverticulosis Angiodysplasia Cancer Polyps Inflammatory bowel disease Radiation proctocolitis Infectious colitis Ischemic colitis Anorectal disease Hemorrhoids Anal fissures Rectal ulcers Fistula in ano Rare Causes Portal hypertensive colopathy Small bowel...

Diverticulitis

The treatment of uncomplicated diverticulitis is relatively straight-forward in most cases. Patients usually respond to broad spectrum antibiotics (ciprofloxocin 500 mg twice daily combined with metronidazole 500 mg 4 times daily) given orally in an outpatient setting. Many practitioners choose to also limit the patient's diet during the first 48 to 72 hours of treatment depending on the severity of symptoms. Diet alterations may include keeping the patient on liquids, with or without high calorie supplements such as Ensure, or simply a low residue diet devoid of fiber. Pain control is important, especially if the patient is ill enough to be admitted to the hospital. If patients respond clinically in the first 48 to 72 hours with significant resolution of symptoms, they are generally transitioned back to a regular diet and eventually to a high fiber diet. Patients who do not respond to conservative management as an outpatient should be considered for inpatient treatment with IV...

Supplemental Reading

Jensen DM, Machicado GA, Jutabha R, Kovacs TOG. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000 342 78-82. Lefkovitz Z, Cappell MS, Lookstein R, et al. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia. Med Clin North Am 2002 86 1357-99. Stollman NH, Raskin JB. Diagnosis and management of diverticular disease of the colon in adults. Am J Gastroenterol 1999 94 3110-21. Strate LL, Orav J, Sapna S. Early predictors of severity in acute lower

Indications For Procedure

Indications for colectomy include benign and malignant diseases (Table 1). The most common benign conditions are diverticulitis, lower gastrointestinal (GI) hemorrhage, ulcerative colitis, sigmoid volvulus, and penetrating trauma. The most common malignant condition is adenocarcinoma of the colon. When colectomy is being considered for benign conditions many variables are considered prior to recommending surgery. For example, in cases of sigmoid diverticulitis or sigmoid volvulus, recurrence rates are important. After one episode of sigmoid diverticulitis, the risk of a second episode is about 15-20 . However, if a patient has a second episode, the risk of subsequent attacks of diverticulitis rises to about 50 . Therefore, most surgeons recommend elective segmental colectomy after resolution of a second episode.

Contraindications

Purely elective colon surgery for a benign condition could be postponed for long periods while medical issues are addressed. Conversely, a patient with a life-threatening colonic condition, e.g., perforated diverticulitis with generalized peritonitis may require urgent surgery despite the patient's fragile condition.

Pathogensesis And Pathology

Actinomyces species are agents of low pathogenicity and require disruption of the mucosal barrier to cause disease. Actinomycosis usually occurs in immunocompetent persons but may afflict persons with diminished host defenses. Oral and cervicofacial diseases commonly are associated with dental caries and extractions, gingivitis and gingival trauma, infection in erupting secondary teeth, chronic tonsillitis, otitis or mastoiditis, diabetes mellitus, immunosuppression, malnutrition, and local tissue damage caused by surgery, neoplastic disease, or irradiation. Pulmonary infections usually arise after aspiration of oropharyngeal or gastrointestinal secretions. Gastrointestinal infection frequently follows loss of mucosal integrity, such as with surgery, appendicitis, diverticulitis, trauma, or foreign bodies (1). The use of intrauterine contraceptive devices (IUDs) was linked to the development of actinomycosis of the female genital tract. The presence of a foreign body in this setting...

Unanticipated Concurrent Disease

Patients may undergo urgent laparotomy for an acute abdomen (including the preoperative diagnosis of ruptured AAA) and be found to have an intact aneurysm with concomitant intra-abdominal pathology. In general aneurysmorrhaphy is deferred under these circumstances and the acute event is addressed. Valentine et al,2 recently reported an exceedingly high mortality for patients operated on emergently for presumed rupture of an aortic aneurysm when the aneurysm was intact. This was often due to the occurrence of other acute pathology, most often myocardial ischemia. Thus, when these patients are encountered, we believe that aneurysmorrhaphy should be deferred and the acute problem identified and addressed. In many cases, the problem is infectious (appendicitis, cholecystitis, diverticulitis), obstructive or an intestinal perforation. In each circumstance the risk of infection of the aneurysm and the instability of the patient makes delay of aneurysm surgery judicious. Operation should be...

Definition and Causes

Sigmoid Colon Stenosis

D-g Stenosis at anastomosis following sigmoid resection due to diverticulitis. Stenosis not passable. Advancement of the TTS balloon (d). Inflated balloon in the stenosis, filled with water and contrast agent. One can look through the balloon to the stenosis wall and to a certain degree see it dilating (e). Correct positioning of the balloon in the stenosis is controlled endoscopically during the entire procedure (f). In many cases, radiological surveillance is thus unnecessary. d-g Stenosis at anastomosis following sigmoid resection due to diverticulitis. Stenosis not passable. Advancement of the TTS balloon (d). Inflated balloon in the stenosis, filled with water and contrast agent. One can look through the balloon to the stenosis wall and to a certain degree see it dilating (e). Correct positioning of the balloon in the stenosis is controlled endoscopically during the entire procedure (f). In many cases, radiological surveillance is thus unnecessary. Postoperative strictures. The...

Colonic Complications of NSAIDs

Some of the side effects of NSAIDs on the large bowel are rare, such as erosions, solitary or multiple ulcers, inflammation (which may resemble classic inflammatory bowel disease IBD ), aggravation of diverticulitis, or even appendicitis in the elderly (Bjarnason et al, 1987). Treatment is the same as for the underlying disease, with discontinuation of the particular NSAID and with COX-2 selective agents being the preferred antiinflammatory analgesic.

Richard KozarekMD

Occlusive nonocclusive Abdominal aortic aneurysm repair Postoperative anastomotic Diverticulitis Irradiation Miscellaneous Infections Caustic enemas Circumferential endotherapy loss and bleeding may be particularly important signs that push the clinician into an aggressive workup that requires full examination of the stricture in question. Whether the latter occurs endoscopically using small caliber instruments, contrast injection through a catheter placed within a stricture, or even a capsular endoscope for mid to distal strictures (recognizing impaction and obstruction as a potential problem) or occurs with radiologic imaging in conjunction with tumor markers (eg, CEA, CA19-9, CA-125), it is most important to rule out a malignant etiology of the stricture. The latter may be relatively evident such as the invariable young and female patient who develops gastric outlet obstruction in the setting of chronic NSAID use for headaches or the individual who develops an anastomotic leak or...

Patient Examination

Therefore, angiography can be helpful in those patients who have undergone multiple previous procedures or in whom regional or distant tissue flaps are being considered to aid in reconstruction. Finally, an evaluation for the presence of GI pathology, including enterocutaneous fistula, inflammatory bowel disease, other inflammatory processes including diverticular disease, or recurrent tumor is vitally important before allowing the patient to enter the operating room. Optimization of these problems and their associated comorbidities, including malnutrition, abscess drainage, and assessment and control of the extent of any underlying GI pathology are of the utmost importance both in the short term postoperative outcome and in long term results of abdominal wall reconstruction.

Figure 1222

Diverticulitis and inflammatory bowel disease. Patients with a history of symptomatic diverticulitis must be evaluated for partial colectomy before transplantation. Inflammatory bowel disease generally should be quiescent at the time of transplantation. (From Kasiske and coworkers 1 with permission.)

Infection

Most patients who present with acute diverticulitis complain of acute onset left lower quadrant abdominal pain. Fever is often present as well and the patient may report bowel changes such as diarrhea or constipation. Bleeding is not generally associated with acute infection, and although patients may report association with a particular type of food, diet is generally not a contributing factor. Diagnostic studies should be aimed at both demonstrating the presence of inflammation as well as ruling out complications such as abscess, fistula, or free perforation. Computed tomography (CT) scan is probably the single best test in the setting of presumed acute inflammation because it reliably detects the location of inflammation and also detects any associated abscess that may be present. Fistulas may also be demonstrated if air is seen in adjacent structures such as the urinary bladder. Colonoscopy and contrast enema studies are less desirable in the acute setting as they carry the risk...

Abdominal

This is a chronic, localized, inflammatory process that often occurs weeks, months, or years after the integrity of the gastrointestinal mucosa is broken by surgery for acute appendicitis with perforation, or for perforated colonic diverticulitis, or by emergency surgery on the lower intestinal tract after trauma. Occasionally, abdominal actinomycosis may manifest without identifiable predisposing factors. The ileocecal region is involved most frequently (usually following appendicitis with perforation), with the formation of a mass lesion. The infection extends slowly to contiguous organs, especially the liver, and may involve retroperitoneal tissues, the spine, or the abdominal wall. Hepatic, renal, and splenic disseminations are uncommon complications (5). Persistent draining sinuses may form, and those involving the perianal region can simulate Crohn's disease or tuberculosis. The extensive fibrosis of actinomycotic lesions, presenting to the examiner as a mass, often suggests...

Clinical Features

The symptoms of large bowel CD are similar to those of UC, usually presenting with diarrhea and rectal bleeding. In contrast, however, because of the transmural nature of CD, there is a greater likelihood that the symptoms will be associated with abdominal pain, fever, and weight loss. The distinction between UC and Crohn's colitis, although not possible in up to 10 to 15 of cases, is important with regard to potential medical interventions (eg, antitumor necrosis factor TNF therapy) and surgical management (the potential for creation of an ileal pouch anal anastomoses is less with CD due to disease recurrence in the ileal pouch). Perianal disease, present in 30 to 40 of patients with Crohn's colitis, is another differentiating feature from UC and is present in up to 80 of cases of Crohn's proctitis. Crohn's colitis is also more common in older patients (> 80 of Crohn's patients older than 40 years have colonic involvement) and in this population it must be differentiated from...

Complications Spasm

The changes in the wall of the colon seen with diverticu-losis can result in a syndrome of intermittent abdominal pain and spasm that mimics IBS. Symptoms are generally mild and are not associated with fever or signs of sepsis. Treatment is usually conservative and includes measures such as a high fiber diet and pharmacologic agents aimed at decreasing colon spasm, such as hyoscyamine. Symptoms are usually self-limited but may recur with some degree of regularity. Many patients with presumed recurrent diver-ticulitis may actually be suffering from intermittent spasm associated with diverticulosis. An antibiotic regimen is often started without radiographic confirmation of true diverticulitis, and in patients with spasm alone, it is simply the tincture of time, not antibiotic therapy, which has improved their condition. This fact is important to remember because true recurrent diverticulitis may warrant surgical intervention whereas the treatment of pain associated with spasm alone...

Normal Sigmoid Colon

Sigmoid Colon Pictures

The sigmoid colon is located in the lower left abdomen between the rectum and the descending colon. Its name is derived from its S shape (sigma the Greek letter S). The sigmoid colon is completely intraperitoneal, attached and supplied by its own mesentery (mesosigmoid) to the posterior abdominal wall. Due to its intraperitoneal position, the sigmoid colon is usually highly mobile. However, previous lower abdominal surgery, especially gynecological operations and inflammation (e.g., diverticular disease), can cause adhesions, fixing it to the abdominal wall, making passage difficult, and in rare cases even impossible. The length of the sigmoid colon can vary greatly usually 15-30 cm long, it can be significantly longer (a so-called elongated sigmoid, not considered a pathology), which can lead to looping, and create significant problems for advancing the endoscope. As already mentioned, there is no clear anatomical demarcation at the distal end between the sigmoid colon and the...

Extrahepatic disease

Double Contrast Barium Enema

On routine CT, polypoid or annular lesions can be well-appreciated because of their enhancement and more solid appearance compared with stool (Fig. 9). Associated findings, such as lymphadenop-athy, peritoneal implants (Fig. 10), tumor penetration through the bowel wall, and colonic obstruction, can be well-appreciated. Tumor appearances may vary from a discrete mass narrowing the lumen, to bowel wall thickening (see Fig. 10), to a necrotic mass appearing much like an abscess. In cases of associated inflammation and microperforation, the primary differential diagnosis is perforated diverticulitis. The presence of lymph nodes may help distinguish tumors from diverticulitis, whereas many other findings are shared by both 62 . Tumors may intussuscept and be easily recognized in longitudinal (Fig. 11) or axial plane. Mucinous tumors may be quite bulky. If mucinous colonic or appendiceal tumors perforate, patients may present with pseudomyxoma peritonei at CT (Fig. 12). Pericolic tumor...