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 dog [ Music, ], [ Applause, ].
So diverticulosis is simply the presence of these sac-like protrusions. In the large intestine, through the colon and 50 % over the age of 60, we’ll 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 fiber somehow alters the colonic motility, creating increased pressure within parts of the bowel, such as the left side of the bow, 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 of the lumen of the bowel wall. Interestingly, the Asians seem to have a far increased risk of right-sided that right, colonic diverticulosis, whereas in the West we see left-sided predominance, we’re not really sure.
Why is that? Is that difference, [, Music, ], so diverticulitis is the acute inflammation of the diverticula. These little sacs 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 a food residue at the neck of the diverticulum, the SAC that leads to inflammation, and maybe a micro perforation little tear with collection of bacteria, but the other thought is – and this is not neutral e exclusive – Is that there’s damage to the blood vessels at the neck of that sac 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 a 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 hospitalize 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 in two 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. The important factor is that you see a doctor or ghost accident an emergency, 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 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 may be 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 an emergency. You may see your GP and he may manage you depending on how he feels you are on your clinical examination, but clinically you can diagnose it oftentimes. If you’re in a aney, we will obtain a CT scan for imaging to actually see if there’s any complications of diverticulitis. Although complications are rare, are less common, they include things like abscess formation, which is a localized 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 is 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 diverticula, 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 in 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 your 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: [ Music ] you [, Music, ],