Diverticulitis Symptoms 101: What is It, Causes, Symptoms, and How to Prevent
Wednesday, September 19, 2018
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diverticulitis symptoms via healthline.com |
Hey guys, in this article we're going to talk about diverticulitis a lot of people always ask me but what is diverticulitis and a lot of patients come in they have diverticulitis and never heard
of it they want to know what it is and there's a little confused about things so this article we're
going to go over diverticulitis alright so definition first of all I'm going to take a little a little
dance academy lesson as usual okay so this is you can't see that right there so this is a crude
drawing of the colon and the colon is the portion of the bowels the last portion of the bowels
which basically might throw this little thing here which moves the liquid stool which comes
into here this is the small bowel goes into what we call the cecum and then it goes up the
ascending colon across the transverse colon and down the descending colon along this sigmoid
colon because it's shaped like an S and then out the rectum okay and that would be the anus
down there so basically the colon removes a lot of water from the stool that comes in liquid
here this part here and then it's liquid and it's the water gets removed of some electrolytes get
removed and then it becomes solid somewhere over here and then goes out the infamous
poop chute hood down there right so what happens in diverticulitis never have seen like a
little inner tube and the inner tube gets a little weak spot in it right and you have a little blip
right where I'm going to go and draw right here okay so this is what happens you see this little blip right here oh what a mouth over there so the wall of the colon basically gets a weak spot
and you have a like a little outpouching okay a little bubble and that's a diverticulum and
diverticula with a a e is singular and diverticulum actually I've seen there two diverticulitis
that's not senior anyway I don't know it is multiple but anyway that reticula I think is maybe
anyway here we go so there's lots of them over here and generally they happen in this sigmoid
colon like this sometimes it can happen in the a sitting : I'm going to talk about the ones
here we'll talk about the ones here in a second so when these little things here they can
happen and generally maybe you have some pain for a short period of time you have one of
those things from your lips develop they can do nothing they can just sit there all the time
and you can never have any problems with them or what could happen is they get blocked
okay I'm gonna go little drawing in my internal drawing you see the neck of them are the base
of those things they're blocked off okay and what is in the colon besides poop bacteria and so
bacteria gets in these things and they get trapped there's no place to go so then bacteria what does what they do best and proliferate right and then we have a little little thing there be
nothing there it bursts okay or it gets it's actually has micro perforations and that is
diverticulitis okay i ts means inflammation but diverticulitis is when you have a diverticulum
that particular by themselves are not infected they can be be not infected and then you can
have a diverticulitis which is infected they can have just usually just one gets infected and you
Micro perforations and then we have like a little bit of a continuum where I talked about last time or from will say divert let's see we'll have micro if I was good I've done this before
perforation to gross rupture and once again we have a continuum okay something like this so
we have where are we micro perforation you can't even read because I have terrible
handwriting and then on this little continuum here we have gross perforation or gross rupture
of the colon so that would be where you just have a big ol hole whoops you just have a big ol
blowout you know I'm saying you have a big blowout like that and you just have stool spill
into the abdomen bad news you couldn't get that and then in the in the meantime we have
maybe a little bit of spillage but not a lot and we can form what's called an abscess okay an
abscess is something like this where you have the book you have a micro perforation like this
or a small blowout and the body walls it off and all this stuff in here is bacteria the bacteria
gets caught in there but the body contains it and it doesn't go everywhere and so you can get
fevers and chills and get sick but that is part of the continuum okay I just want to do that the
little definition there and then we'll talk about the symptoms and things so a particular this is
basically an infection in the colon but after you have these little diverticula they get ruptured
you can have micro perforation you can have a small like a slightly bigger perforation with
abscess or you have gross rupture and most of the time you have this micro perforation which
is treated with antibiotics but I'll go over that side so symptoms associated with diverticulitis
are pain abdominal pain and most of the time so if I go like this this is the left side and this is
the right side okay so most of the diverticulitis happens on the left side you can have it over
here it's just not very common okay you can have diverticula over here they're less common
more mostly the diverticular over here bleed so we generally talked about deputy guys we're
talking about left side so left sided lower abdominal pain is generally what's going on so you you know down here into what's the right side right side is appendicitis we talk about right side
abdominal pain with fevers and chills we think of appendicitis left side abdominal pain with
fevers and chills we generally think about diverticulitis okay so if you have progressing of
Donald Payne maybe over 24-48 hours which is not going Kate not going away getting worse
fevers and chills each but I go see somebody okay if it's real bad just somebody lessons in less
than 24 hours so that's generally the what what folks feel you can have some nausea vomiting you can have diarrhea you can have constipation now let me mention real quick why do we
get these and it is essentially because the colon is having a lot of pressure okay so as you can
imagine the colon is kind of like a muscular tube and it squeezes along the way like this right it
squeezes everything down so if the squeeze you generate too much pressure in the colon that
you can have that's just like the the weakening of the to the inner tube the wall there's certain
parts of the colon where the wall is a little bit weaker and that's where you have those little
outpouching things and so I lost my train of thought what was I thinking symptoms so fevers chills nausea vomiting diarrhea constipation either one a physical exam on talked about
physical physical exam same thing when you go the doctor and they press on your belly and if
they press over here it doesn't hurt and it's a right side and then they press over here and
you're like oh that hurts then it may be some diverticulitis it may be a micro perforation if
they push over here and it hurts over here then that may be a gross rupture that's what we call
peritonitis and that's because the inside of the abdominal wall tough lining is really really
angry and no matter where you push it hurts over here okay so that's the basically physical
exam for that the laboratory values generally patients have a elevated white blood cell count
and that is because the white blood cells are trying to fight some sort of infection and you
have a rise in white blood cells in the blood and so your doctor will probably get you that and
then typically it doesn't affect the blood so like your hemoglobin or your manic rate doesn't
really get affected however if you have a right-sided diverticulitis or excuse me a right side or
diverticulum over here those often bleed more than they get infected and so sometimes if you have gross blood from the rectum then you may have a diverticulum that is bleeding x-rays I
gotta let me cheat my cheat sheet here so x-rays typically how its diagnosed is if you have
abdominal pain you go see your family physician or you go to emergency department
generally you get up just in a plane act what we call plane x-ray it looks from back to front and you see the bones and all that stuff you may see some gas but you don't see really the
diverticulum or the infection so much but the cat scan is much better for that so you probably
get a cat scan if you see nothing on the initial x-ray you get a cat scan and that can show you
the diverticulum that's about the best way to adult sees it you probably will see diverticulum if
you don't have an infection if you do have an infection that's the best way to see it
diverticulitis and also the abscess which we talked about and then treatment so there's a few
ways we can treat this depending on what is going on so if it's a micro perforation and we
don't think there's spillage of stool into the abdomen and there's not an abscess and it's not
gross spillage then we can generally treat those with antibiotics sometimes you need a little bit
of IV antibiotics say like you stay in the hospital for 24 hours you get the IV antibiotics then
you feel much better the next day and you go home and you stay on oral antibiotics for about
eight to eight to fourteen days depending on your severity if you have an abscess so that's a
little different what you do depending on how big the abscess is if it's over two centimeters
you may stick well maybe I shouldn't say stick but you put a needle you place a needle gently into the abscess okay this is done under a radiologic guidance so c2e get a cat scan or an
ultrasound and you can put a needle through the skin after you're not skin into the abscess and
suck out the pus basically that's a fancy way of saying it but that's what you do and you can
get that and sometimes you leave a drain like a tube in that cavity and sometimes you can
suck out the pus and you don't need to leave a drain and so you'd also get antibiotics for that
depending on how big the abscess is depending on where it's located all that stuff you can have
that done and you may have antibiotics for two weeks to six weeks depending on severity so
then lastly is the surgical treatment so after you have an abscess or you have diverticulitis if
you have a little tiny diverticulitis for you know it's a micro perforation you get a cup you get
some antibiotics it goes away you feel good it happens again if when you start having it
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happen more than once then you start thinking about well maybe you need that portion of
the colon removed because if it perforates right here now here's the trick now listen to this if
it perforates and you have gross contamination of stool in the abdomen you may need an
emergent surgery with a removal of the that portion of the colon and a colostomy bag right
you know where you have the bag where you poop into out of your skin into the bag bad news
nobody wants that so that's the big deal about diverticulitis you have a recurrent recurrently if
you have an emergency surgery for it maybe a colostomy bag now we're definitely surgeons in
general or moving more towards not doing the bag so much and trying not to do that but if
it's grossly infected there's lots of poop everywhere if you do that and you close it all up you
could have a bad infection so depending on the situation you may end up with that may not but that's the bad stuff okay um so and then so that was kind of like the emergency portion
right if you have have an emergency if you have the gross rupture you get real sick right you
go in the hospital you have emergency surgery on the elective side so you get diverticulitis
and it's micro perforation so you get that a couple times your surgeon and or doctor may
recommend you have that portion of the colon out and on the draw this portion right here
which is generally the sigmoid portion sigmoid colon right here with the little s here the little
s turn that's a sigmoid portion so you get the portion of the colon and when your surgeon goes
in there they look for all these diverticula and they say okay well there's no diverticular about right here let's go here and so generally that's about the sigmoid colon and then you come
down here and say okay there's no diverticular here this looks pretty good stuff down here
we'll leave that we'll take this portion out and then if you have an elective in elective surgery
you can put these back together and hook you back up the same surgery and you don't have to
have a colostomy bag so that's a good deal so all right that is my spiel on diverticulitis I hope
you like that I hope it makes a little bit more sense hope it helps you to avoid the colostomy
bag because nobody likes that and yeah you know where to find me dr. buck Parker com I will see you later you.
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