The pathophysiology between diverticular disease (diverticulosis) and diverticulitis
The pathophysiology of diverticulosis and diverticulitis is still insufficiently studied by scientists and existing knowledge has many gaps. However, several differences need to be distinguished between the two conditions and their causes. Diverticulosis implies the development of diverticula (pouches) in the human digestive tract and is asymptomatic. Diverticulitis suggests inflammation or infection of these sacs and has several symptoms. According to Schieffer et al. (2018), the development of diverticulosis occurs due to lifestyle, genetic predisposition, and the environment. In particular, a low-fiber diet and other causes create pressure on the colon and form diverticula. Strate and Morris (2019) note that diverticulosis can develop in diverticulitis in the case of chronic inflammation and alterations in the microbiome and neuromusculature. As a result, the mucosal barrier does not work correctly, the diverticula become inflamed, and symptoms appear.
The clinical findings from the case that supports a diagnosis of acute diverticulitis
The acute diverticulitis diagnosis is supported by characteristics and symptoms with which the patient was admitted to the hospital. Vomiting, dehydration, nausea, constipation, tachycardia, abdominal pain, and low fever are essential signs for diagnosing this condition. Moreover, the hyper-resonance abdomen indicates bloating in physical examination, and an x-ray demonstrates a bowel-gas pattern consistent with an ileus. Found rebound tenderness in palpation is another argument for diagnosing acute diverticulitis (Pemberton, 2019). A crucial aspect of diagnosing this condition is a computerized tomography (CT) since it has a proven high level of accuracy, specificity, and sensitivity (Sugi et al., 2020). In this case, CT showed a distended small bowel, which confirms the ileus and indicates a diagnosis.
Risk factors for acute diverticulitis
Various studies support the existence of risk factors for acute diverticulitis. In particular, special attention is paid to lifestyle, taking some drugs, and immunosuppression (Strate & Morris, 2019). The first factor, lifestyle, includes diet, bad habits, and physical activity. Nutrition plays a key role, as a small number of foods with fiber, much fat, and red meat increase the risk of developing diverticulitis. A balanced diet, obesity prevention, quitting smoking, drinking alcohol, and incorporating active exercise, in turn, reduce risks.
A specific group of drugs may also increase the likelihood of acute diverticulitis. Studies have found a strong association between nonsteroidal anti-inflammatory drugs (NSAIDs) and the occurrence of the considered disease (Strate & Morris, 2019). Moreover, NSAIDs also contribute to the emergence of complications of diverticulitis. Other drugs associated with the development of the disease are corticosteroids and opiate analgesics. In turn, research on risk-reducing drugs is not accurate enough (Strate & Morris, 2019). Immunosuppression through drugs, chemotherapy, and other methods, is a third risk factor. Impaired recovery and healing processes support the development of diverticulitis, and reduced immunity cannot respond to it.
Why antibiotics and IV fluids are indicated
Treatment of acute diverticulitis involves specific actions depending on the presence of complications and the patients’ ability to take care of themselves. The use of antibiotics and fluids intravenously are standard methods of treating this disease without complications but with the patient’s need for care (Huston et al., 2018). Fluids provide recovery of the patient after dehydration provoked by diverticulitis. The antibiotics are aimed at stopping infections and preventing the spread of bacteria. While such treatment is one of the most common and accepted in hospitals, the medical community questions the need for antibiotics in a considered disease. In particular, Huston et al. (2018) found evidence giving reason not to give antibiotics to patients without co-morbidities. However, given the honorable age of the patient from the case, one can assume that the use of antibiotics is reasonable.
References
Huston, J. M., Zuckerbraun, B. S., Moore, L. J., Sanders, J. M., & Duane, T. M. (2018). Antibiotics versus no antibiotics for the treatment of acute uncomplicated diverticulitis: review of the evidence and future directions. Surgical Infections, 19(7), 648-654. Web.
Pemberton, J. H. (2019). Clinical manifestations and diagnosis of acute diverticulitis in adults. Uptodate. Web.
Schieffer, K. M., Kline, B. P., Yochum, G. S., & Koltun, W. A. (2018). Pathophysiology of diverticular disease. Expert Review of Gastroenterology & Hepatology, 12(7), 683-692. Web.
Strate, L. L., & Morris, A. M. (2019). Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology, 156(5), 1282-1298. Web.
Sugi, M. D., Sun, D. C., Menias, C. O., Prabhu, V., & Choi, H. H. (2020). Acute diverticulitis: Key features for guiding clinical management. European Journal of Radiology, 128, 109026. Web.