A CASE STUDY ON DIVERTICULITIS

BIOLOGY HOLIDAY HOMEWORK

MAYUKHI PAUL
CLASS X A
ROLL NUMBER
Introduction
The human digestive system consists of the gastrointestinal tract and the accessory organs of
digestion (the tongue, salivary glands, pancreas, liver, and gallbladder). In this system, the process of
digestion has many stages, the first of which starts in the mouth. Digestion involves the breakdown
of food into smaller and smaller components, until they can be absorbed and assimilated into the
body. Each part of the digestive system is subject to a wide range of disorders which may occur due
to the presence of pathogens or autoimmune responses of the human body. Through this project
we shall learn about diverticulitis, a gastrointestinal disease.

Gastroenteritis
Gastroenteritis is the inflammation (itis) of the stomach (gastro) and intestine (entero). It is mainly
caused by bacteria or virus which enters the gastrointestinal tract through the oral cavity.

Causes of gastroenteritis
The intestinal immune system protects the digestive system from
harmful microbes. Sometimes the immune system is unable to check
the entry of microorganisms into the gastrointestinal tract which may
cause inflammation, indigestion or other symptoms of
gastroenteritis. Different type of microbes can cause gastroenteritis:

Viral gastroenteritis: These viruses multiply within the epithelial

tissue layer of the digestive tract. They inhibit the process of
absorption in the intestine and cause the intestine to secrete water;
whereas its main function is to absorb water.
Rotavirus, norovirus, adenovirus and astrovirus are some of the
viruses which cause gastroenteritis.

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Bacterial gastroenteritis: Bacteria mainly
affects the colon. They produce toxins which
hinder the absorption of water and
electrolytes. Bacterial infection also causes
intestinal ulceration and bleeding.
Campylobacter species, Escherichia coli,
Salmonella, Shigella, Clostridium difficile, and
Vibrio cholerae causes cholera.

Parasitic gastroenteritis: Some parasites cause

bleeding, ulceration and micro abscesses in the
intestinal walls. For example: Giardia lamblia,
Entamoeba histolytica, and Cryptosporidium
species.
Long term use of non-steroidal anti-
inflammatory medications, used for treating
inflammatory diseases such as arthritis may
damage the gastrointestinal tract by causing
disorders in mucous secretion, bleeding and
ulcer. In some people, consumption of gluten
triggers an autoimmune response which
destroys enterocytes (cells present in the inner
lining of the intestine, which help in the
absorption of nutrients) and damages the
structure of the intestinal wall.

Diverticulitis
Diverticulitis is a gastrointestinal disease in which inflammation of diverticula (singular: diverticulum)
takes place. Diverticula are small sac-like out pouching of mucosal and sub-mucosal layers of the
colonic wall. Many people having diverticula, do not experience any symptoms. This condition is
known as diverticulosis.
Diverticulitis is included in the domain of western diseases since it is more common in European and
North American countries than in Asian and African countries. The symptoms of diverticulitis are
similar to that of Irritable Bowel Syndrome. The factors which contribute to diverticulitis are: genetic
structure, increase in disease causing bacteria in colon, decrease in healthy gut bacteria, obesity,
smoking and consumption of non-steroidal anti-inflammatory drugs (NSAIDs). Patients may have
chronic abdominal pain, tenderness, bloating and changes in bowel habits. There is evolving evidence
that inflammation, dysbiosis, visceral hypersensitivity and colonic dysmotility may all play a potential

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 role in the etiology of diverticular disease. Multiple
clinical trials are ongoing to evaluate a few agents
that act on these factors. Diagnosis is primarily done
by colonoscopy, blood tests, lower gastrointestinal
series and CT scan. The disease becomes more
frequent with age and is common in people over the
age of 50 years.

Objectives
The main objectives of this study are:
1. To get a general overview of gastrointestinal diseases.
2. To investigate the etiology and remedies of diverticulitis.
3. To review the methods of diagnosis of diverticulitis.

History of the disease

Epidemiology
Diverticular disease is more prevalent in the Western world. It can affect patients of all age groups,
but its frequency increases with age. The disease is more likely to be complicated in young
individuals. Even though diverticular disease can manifest significant symptoms and complications,
about 80-85% of people with this condition are asymptomatic. 75% of symptomatic patients have
painful diverticular disease without inflammation. The prevalence of diverticular disease has
increased from an estimated 10 percent in the 1920s to between 35 and 50 percent by the late
1960s, and 65 percent of those currently 85 years of age and older can be expected to have some
form of diverticular disease of the colon. Less than 5 percent of those aged 40 years and younger
may also be affected by diverticular disease. Among patients with diverticulosis, 4 to 15% may go on
to develop diverticulitis.

Causes of diverticulitis
Pathophysiology
A low fiber diet increases the risk of diverticulitis. Age-related changes in the connective tissue of
the colon include an increase in collagen crosslinking and increased elastin content that may lead to
increased colonic rigidity. Low fiber diets can reduce stool volume and predispose individuals to
develop constipation that in turn leads to increased intra-luminal pressure and colonic wall tension.
Contractions separated the colon into distinct compartments of high intraluminal pressures termed
segmentation. Intra-colonic pressures have been recorded in patients with diverticulosis.
Segmentation of the colon can generate excessively high pressures favoring herniation. The
hypothesis is that diverticula develop due to high intra-colonic pressure at points of weakness in the
muscular wall. Alteration of bacterial flora occurs as a result of slow colonic transit and stagnation of
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fecal material in the diverticula seen in colonic diverticulosis, which in turn triggers intestinal
inflammation by impairing mucosal barrier function.

Effects of diverticulitis

While most people with colonic diverticulosis remain asymptomatic, about 20% will experience
complications. The two most common and well-recognized complications are acute episodes of
bleeding and diverticulitis. Patients may also experience chronic and vague gastrointestinal
symptoms including abdominal pain, bloating, constipation and diarrhea.

Acute diverticulitis is characterized by inflammation, microperforation and abscess formation; 25–

33% of these patients may have recurrent episodes. In patients with gastrointestinal symptoms
without overt diverticulitis, low grade inflammation, gut dysbiosis, visceral hypersensitivity and
colonic dysmotility have been identified as potential contributing factors to symptoms.

Stages of diverticulitis
Although diverticulosis remains asymptomatic in the
majority of patients, when patients start to have
symptoms related to this condition, it becomes
symptomatic diverticular disease. Classification of
diverticular disease is largely based on symptoms.
Stages of the disease begin with the development of
diverticulosis, to asymptomatic disease, to
symptomatic uncomplicated diverticular disease
(SUDD) and finally to complicated disease when
patients develop abscesses, phlegmon, bleeding,
fistula and sepsis. Symptoms can be acute or chronic. Source: Sheth, A., Longo, W.E., & Floch,
M.H. (2008). Diverticular Disease and
Diverticulitis. The American Journal of
Gastroenterology, 103, 1550-1556.
Diagnosis of diverticulitis
People with the above symptoms are commonly studied with computed tomography, or CT scan.
The CT scan is very accurate (98%) in diagnosing diverticulitis. In order to extract the most
information possible about the patient's condition, thin section (5 mm) transverse images are
obtained through the entire abdomen and pelvis after the patient has been administered oral and
intravascular contrast. Images reveal localized colon wall thickening, with inflammation extending
into the fat surrounding the colon. The diagnosis of acute diverticulitis is made confidently when the

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involved segment contains diverticula. CT may also identify patients with more complicated
diverticulitis, such as those with an associated abscess. It may even allow for radiologically guided
drainage of an associated abscess, sparing a patient from immediate surgical intervention.
Prevention and cure of diverticulitis

The best way to prevent diverticulitis is to modify your diet and lifestyle.

 Eat more fiber by adding whole-grain breads, oatmeal, bran cereals, fibrous fresh fruits,
and vegetables to your diet. However, take care to add fiber gradually. A sudden switch
to a high-fiber diet can cause bloating and gas.
 Bulk up your diet by adding an over-the-counter preparation containing psyllium,
derived from the plant Plantago psyllium. You can also try ground psyllium seed: Once a
day, add 1 teaspoon ground psyllium seed over any cold liquid and drink within a few
minutes of preparing, before the mixture gels.
 Drink plenty of fluids (at least eight 8-ounce glasses of water a day) if you increase your
intake of fiber.
 Avoid refined foods, such as white flour, white rice, and other processed foods.
 Prevent constipation Polyethylene glycol (MiraLax) is a useful laxative for short-term
use in constipation.
 Exercise regularly. Exercise can help the muscles in your intestine retain their tone,
which encourages regular bowel movements. If you have the urge to move your bowels,
don't delay or ignore it.

If you have a mild case of diverticulosis, your doctor may have you eat a high-fiber diet to make
sure the bowels move regularly and to reduce the odds of getting diverticulitis. Mild
diverticulitis infection may be treated with bed rest, stool softeners, a liquid diet, antibiotics to
fight the inflammation, and possibly antispasmodic drugs. However, if you have had a
perforation or develop a more severe infection, you will probably be hospitalized so you can
receive intravenous (through a vein) antibiotics. You may also be fed intravenously to give the
colon time to recuperate. In addition, your doctor may want to drain infected abscesses and
give the intestinal tract a rest by performing a temporary colostomy. A colostomy creates an
opening (called a stoma) so your intestine will empty into a bag that is attached to the front of
the abdomen. Depending on the success of recovery, this procedure may be reversed during a
second operation.

Conclusion
Epidemiological and anatomic evidence indicates that approximately 60% of humans of
westernized societies living into the sixth decade will develop diverticulosis of the colon. The
cause remains unknown, but epidemiological studies indicate it is a combination of decreased
dietary fiber intake and increased intra-colonic pressure. Medical treatment is preferred with
appropriate antibiotic therapy and variations in fiber intake.
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Bibliography
i. https://www.webmd.com/digestive-disorders/understanding-diverticulitis-treatment#1
ii. https://en.wikipedia.org/wiki/Human_digestive_system#Clinical_significance
iii. https://www.ncbi.nlm.nih.gov/pubmed/15115921
iv. https://en.wikipedia.org/wiki/Diverticulitis#Treatment
v. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625022/
vi. https://medlineplus.gov/ency/presentations/100158_6.htm
vii. https://www.khanacademy.org/test-prep/nclex-rn/gastrointestinal-
diseases/gastroenteritis-rn/a/what-is-gastroenteritis/

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