Diverticulosis of the digestive tract
Introduction
Introduction to digestive tract diverticulosis Digestive tract diverticulosis refers to the local cystic bulging of the digestive tract, both true and false. The former refers to full-thickness bulging, the latter only has mucosa and submucosa without muscle bulging, most of the diverticulum bulges out of the digestive tract, and a few bulges into the cavity, called intraluminal fistula, multiple diverticula There is also a disease called diverticulosis. The disease is seen in the whole digestive tract, with the colon being the most common, followed by the duodenum, and the stomach diverticulum is the least common. Diverticulosis with symptoms or complications is called symptomatic diverticulum or diverticulosis and requires treatment. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific population Mode of infection: non-infectious Complications: intestinal obstruction abscess
Cause
Etiology of digestive tract diverticulosis
Because the blood vessels in the upper part of the jejunum and the end of the ileum are thicker, the muscle layer of the intestinal wall is weak in the thick blood vessels. Therefore, in these areas, especially in the upper part of the ileum, the diverticulum is more likely to occur. In addition, long-term intake of low-fiber foods causes the intestinal pressure to rise continuously. Related, the elderly are prone to hair loss associated with weakened intestinal wall muscle strength.
Prevention
Digestive tract diverticulosis prevention
Eat less slag of fruit or crude fiber vegetables and irritating foods, so as not to increase bowel movements, make the symptoms worse, eat a liquid diet during the attack, so that the stool is soft and slippery, reducing stagnation, making it easy to discharge from the diverticulum, Before going to bed every night, take 5ml liquid paraffin or senna leaf tea, etc., it is not suitable to do colon enema to avoid perforation.
Complication
Gastrointestinal diverticulum complications Complications, intestinal obstruction, abscess
Complicated intestinal perforation, abscess, hernia, intestinal obstruction, major bleeding, inflammation, perforation, sputum indoor cancer.
Symptom
Symptoms of digestive tract diverticulosis Common symptoms Dysphagia Post-sternal pain Digestive tract Diverticulum bloating Inflammation Sounds hoarseness Heart dysphagia Abdominal pain Indigestion
First, the esophagus diverticulum
1. Pharyngeal-esophageal diverticulum (Zenker's diverticulum) Clinical manifestations of mild dysphagia, food left in the diverticulum can flow back into the mouth, coughing after eating and sleeping, late performance of the recurrent laryngeal nerve compression Hoarseness, when drinking water, there is gas and water and recurrent pneumonitis. When the body examination, a dough-like mass can be found in the neck of the upper part of the clavicle. When the pressure is pressed, the sound of water is emitted. The X-ray swallowing film can confirm the diagnosis. Those who develop cancer need early surgical treatment.
2. The middle esophagus diverticulum is less common, which is the pull-out true diverticulum. Because of the adhesion of the tuberculosis or other inflammatory lesions under the tracheal carina, and the anterior wall of the esophagus, the whole esophagus is pulled, the opening of the diverticulum is large, and the position of the pouch is Higher than the neck of the sac, is not prone to food retention, generally asymptomatic, a few people have difficulty swallowing, very few cases of mediastinal abscess or esophageal tracheal fistula, symptoms can be water sac or balloon dilatation, asymptomatic patients do not need surgery .
3. The upper esophageal diverticulum is the least seen in the esophageal diverticulum. It is a pseudo-diverticulum. It is located 10cm above the lower esophagus. It is more common in men, often accompanied by esophageal fistula, sacral fistula, reflux esophagitis or esophageal hiatus hernia. X-ray examination, CT examination can identify mediastinal tumor, abscess or hiatal hernia, asymptomatic patients do not need treatment, obvious symptoms such as dysphagia, post-sternal pain and cancer need to be surgically removed.
Second, most patients with gastric diverticulum are asymptomatic. A few complaints of intermittent upper abdominal fullness or lower chest pain after meals or supine, accompanied by nausea, vomiting, heartburn, and food retention in the sputum, common complications are Bleeding.
Third, the small intestine diverticulum
1. Duodenal diverticulum is the most common in the small intestine diverticulum, the vast majority of patients are asymptomatic, about 10% of patients complain of upper abdominal pain and discomfort, accompanied by nausea and suffocation, increased after eating, and inflammation or ulceration, the symptoms are more Heavy or long-lasting, there may be tenderness in the diverticulum, about 27% of the diverticulum around the ampulla of the spleen with cholelithiasis, can also cause common bile duct obstruction, cholangitis, recurrent pancreatitis, other complications are bleeding and perforation, Uncommon, hemorrhage may be caused by mucosal erosion or vascular dysplasia of the diverticulum. It may also be caused by penetrating nearby mesenteric blood vessels. Perforation may reach the portal vein, biliary tract or pancreas, causing abscesses. The duodenal diverticulum may be concurrently partially or Complete duodenal obstruction, causing full abdominal cramps after meals, relieved after vomiting.
2. The Meckel diverticulum is a true diverticulum at the end of the ileum, which is caused by the ileal end closure of the yolk tube of the embryonic stage. Most of the patients are asymptomatic and have corresponding symptoms when complications occur. When the diverticulum protrudes into the intestine, it can cause Intussusception and obstructive intestinal obstruction, symptoms are vomiting, abdominal distension, constipation or red jam-like stool, ectopic gastric mucosa can secrete gastric acid and pepsin, produce diverticulum peptic ulcer and hemorrhage, are common complications in children .
3. Acquired empty ileal diverticulum This disease is rare, single diverticulum is asymptomatic, multiple sputum indoors have a large number of bacteria, there may be dyspeptic symptoms, such as abdominal pain, flatulence, diarrhea and malabsorption, and there is weight loss, anemia and Fat sputum, empty ileal diverticulosis is one of the common causes of intestinal malabsorption, complications are rare, acute inflammation, bleeding, perforation, small bowel obstruction and internal cancer.
Fourth, the colonic diverticulum is now chronic intermittent left lower abdomen pain, the typical complain of constipation with abdominal flatulence and indigestion, physical examination of the left lower abdomen may have tenderness, sputum and hard and full of fecal block of the colon.
Acquired empty ileal diverticulosis is a kind of diverticulent diverticulosis. It is rare in clinical practice. Because the blood vessels in the upper part of the jejunum and the end of the ileum are thick, the muscle layer of the intestinal wall is weak in the thick blood vessels. Therefore, the diverticulum is more likely to occur in these areas, especially in the upper part of the ileum.
Single diverticulum is asymptomatic. When there are a large number of bacteria in the sputum, there may be symptoms of dyspepsia such as abdominal pain, flatulence, diarrhea and malabsorption, and weight loss, anemia and fatty sputum, and empty ileal diverticulosis is caused by the small intestine. One of the common causes of malabsorption is that complications are rare, including acute inflammation, bleeding, perforation, small bowel obstruction, and internal cancer.
Examine
Examination of digestive tract diverticulosis
(1) Abdominal plain film examination: Abdominal plain film examination of simple diverticulosis is usually normal and therefore of little value. Image characteristics of diverticulitis: The cupping network is: the displacement or stenosis of the intestinal wall, and the mucosa changes. In the proximal or distal intestine of the lesion, multiple abdominal diverticulum can be seen in the abdominal cavity. Abdominal abscess can be found, and multiple gas caused by intestinal colon obstruction Liquid level and flatulent intestines.
(2) Enema: the use of tincture or water-soluble contrast agent for contrast enema is more reliable for the diagnosis of asymptomatic diverticulosis than for colonoscopy. The diverticulum filled with diverticulum is characterized by prominent spheroids of the colon wall. Diverticulum imaging can still be seen after discharge, without inflammation, which may mask the diverticulum. Sometimes the room is turned over or accumulated in stool and is easily confused with polyps. Therefore, it should be observed and photographed in multiple directions. After emptying, the film can improve the diagnostic accuracy.
Diagnosis
Diagnosis and differential diagnosis of digestive tract diverticulosis
The diagnosis of this disease should be differentiated from irritable bowel syndrome, colon cancer, Crohn's disease, and genitourinary diseases. It is worth noting that a small number of patients with diverticulum and irritable bowel syndrome or colon cancer can coexist.
