Divertikulit - it is the intestines disease which is characterized by an inflammation of blindly coming to an end protrusions of its wall (diverticulums). The pathological state is shown by periodic pain in the lower part of a stomach, mainly at the left, frustration of a chair, not plentiful bleedings, temperature increase, the general weakness, is more rare - nausea and vomiting. Endoscopy of a large intestine, an irrigoskopiya, ultrasonography of abdominal organs, a laparoscopy and laboratory methods of a research are applied to diagnostics of a divertikulit. Treatment of pathology consists in prescription of antibiotics and carrying out surgical intervention according to indications.
Divertikulit is the inflammatory disease of intestines developing against the background of stagnation of intestinal contents in diverticulums - protrusions of a wall of a gut. It is observed 1,5 times more often at women in comparison with men. This pathological state mainly is registered at people 40 years are more senior, develops at children less often. In spite of the fact that diverticulums of intestines are available for 50% of people 60 years are more senior, inflammatory process arises only at 20% of these patients. Recently the number of the patients suffering divertikulity sharply grew up that is connected with the use of a large number of meat and flour products. At the same time in Asia where people eat healthier food, the disease is observed less often. Experts in the sphere of a clinical proktologiya and gastroenterology are engaged in development of new methods of treatment of this pathology.
Reasons of a divertikulit
Divertikulit always develops in the place of localization of a diverticulum which has an appearance of blind protrusion of hollow body. Diverticulums are found in a large number of people, however they become complicated divertikulity only at the fifth part of patients. This pathological process arises under the influence of various reasons which provoke an inflammation. In particular, divertikulit can develop at the use of the food poor in cellulose as it leads to locks. If the person uses with food less than 30 g of food fibers a day, then he has the increased risk of developing of this pathology. Such patients have intestines contents dense and insufficiently humidified that results in stagnation of kalovy masses, injury of a mucous membrane, activation and the strengthened reproduction of pathogenic intestinal flora. Against the background of these changes also develops divertikulit.
One of causes of illness is inflammatory process in a thick gut. In particular, divertikulit can develop against the background of spastic, ulcer or infectious colitis, and also various intestinal infections. Infectious agents can get to diverticulums and there actively breed. When weakening the local immune answer of a bacterium lead to development of a divertikulit. The risk of emergence of this pathological process increases with age that is connected with reduction of a tone of muscles and decrease in a vermicular movement. Besides, at elderly people the mucous membrane of intestines becomes thinner, and local immunity gradually decreases.
Diverticulums can inflame at dysbacteriosis or against the background of decrease in the general immunity. Helminthic infection often leads to injury of a mucous membrane and violation of microflora, at the same time there are favorable conditions for reproduction pathogenic a bacterium which occupy a mucous membrane of diverticulums. In emergence of a divertikulit an essential role is played by hereditary predisposition.
Symptoms of a divertikulit
Divertikulit has no typical signs, this pathological state is frequent is accepted to an attack of an acute appendicitis, disease of female genitals or diseases of kidneys. One of the main symptoms of a divertikulit is pain in the lower part of a stomach. Most often pain is localized in its left half. It is connected with what most often strikes a sigmovidny gut. The patient feels dot pain in the concrete place. Pain can be passing or constant, lasting for several days. Pain often amplifies at physical activity, laughter or cough. Also feelings become stronger when pressing on an affected area of intestines. After depletion of intestines pain is not weakened, and, on the contrary, can become is more severe that is explained by tension of muscles of a stomach at a natuzhivaniye.
The following important symptom of a divertikulit is frustration of a chair which is shown by alternation of ponos and locks. Locks can be connected with the fact that the affected area of intestines spazmirutsya, and its gleam is sharply narrowed. At relaxation of a gut in the subsequent there is a diarrhea. Also violation of absorption of water in a large intestine against the background of a divertikulit can be the cause of diarrhea. At this pathological state blood in Calais can be defined. Emergence of bloody allocations is connected with the fact that in the place of localization of a diverticulum at an inflammation the bleeding ulcers and erosion can be formed. Bloody allocations usually not plentiful. They are shown in the form of blood traces on toilet paper or kalovy masses after defecation. Bleedings are noted only at 10% of the patients suffering divertikulity. In rare instances the inflamed diverticulum can be punched, and its contents to get into an abdominal cavity, having caused peritonitis.
At the expressed inflammatory reaction divertikulit it is shown by a hyperthermia. Fever in this case will be connected with hit in blood of specific substances - pyrogenes. Temperature increase at a divertikulita arises owing to activation of the protective forces of an organism directed to fight against an inflammation. Also symptoms of a divertikulit often are nausea, a loss of appetite, vomiting and the general weakness - clinical displays of intoxication.
Diagnostics and inspection
Fizikalny inspection plays an important role in diagnostics of a divertikulit. At a stomach palpation the doctor-proctologist defines the inflamed and spazmirovanny department of a thick gut. The large diverticulum is usually probed in the form of round painful education. When pressing in the field of the inflamed diverticulum there is a morbidity. For diagnostics of a divertikulit tool methods of a research are used: endoscopy of a large intestine (kolonoskopiya), a X-ray analysis with contrast, ultrasonography of abdominal organs and in some cases a laparoscopy. From laboratory methods the general blood test and assessment of biochemical indicators are applied.
Kolonoskopiya is the main method of diagnostics of a divertikulit. This research allows to carry out differential diagnosis of a disease with nonspecific ulcer colitis, locks, intestinal impassability and a tumor of a large intestine. During endoscopy of a large intestine at a divertikulita the damaged mouths of diverticulums with an inflammation of a mucous membrane around them are found. The research gives the chance to specify localization of the bleeding sites and to estimate intensity of bleeding.
The radiographic research of a large intestine with barium (irrigoskopiya) allows to diagnose divertikulit if carrying out a kolonoskopiya is impossible, or it yields ambiguous results. Diverticulums on a X-ray analysis are defined in the form of formations of rounded shape which have diameter from 0,5 to 5 cm. At a divertikulita on the roentgenogram single and multiple protrusions are visualized, and edges of diverticulums have the uneven jagged contours. If against the background of this pathological state there is a perforation of a diverticulum to formation of fistula, then when carrying out a X-ray analysis fistula will be visualized in the form of the contrasted tyazh who extends in the direction of other bodies.
Ultrasonography of abdominal organs allows to find increase in thickness of intestinal walls which often takes place at a divertikulita. If the diverticulum is filled with kalovy masses, then on ultrasonography it can be seen as meshkovidny protrusion with dense contents. The laparoscopy allows to visualize the inflamed diverticulum and at once to remove it. An important role is played by laboratory methods of diagnostics, the general blood test is basic of which. At a divertikulita in the general blood test the stab shift to the left and increase in SOE which are inflammation signs is found .
Treatment of a divertikulit
Treatment is performed in proktologichesky office or is out-patient. The main medicines for conservative therapy of a disease are antibiotics which need to be accepted within 1-2 weeks. During treatment of a divertikulit laxatives and enemas as they increase pressure in intestines are contraindicated. It is also important to adhere to a certain diet which excludes the products causing swelling of intestines and locks. It is necessary to reduce the use of white loaf, rice, milk, grapes and bean. They are recommended to be replaced with bread from whole flour, a sea cabbage, in flakes, the berries, pears and other fruit containing cellulose.
In some cases divertikulity surgical treatment is shown to patients. It is carried out at diverticulum suppuration, intensive bleeding, formation of fistulas, frequent aggravations of a divertikulit, intestinal impassability and peritonitis. Depending on a situation the expeditious treatment consisting at a distance the inflamed diverticulum can be carried out according to plan or urgently.
Forecast and prevention
At timely correct treatment forecast of a divertikulit favorable. For prevention of a disease regular trainings by sport, the use of products rich with cellulose, plentiful drink (not less than 2 liters a day) and immunity maintenance are recommended. Also it is necessary to avoid locks and the injuring manipulations on a large intestine. All these preventive actions will allow to minimize probability of development of a divertikulit in the patients having intestines.