How To Prevent Diverticular Disease Naturally

Managing Diverticular Disease

Managing Diverticular Disease

Stop The Pain. Manage Your Diverticular Disease And Live A Pain Free Life. No Pain, No Fear, Full Control Normal Life Again. Diverticular Disease can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.

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New Diverticulitis Breakthrough Ebook

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New Diverticulitis Breakthrough Ebook Summary

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Contents: EBook
Author: Mark Anastasi
Price: $47.00

My New Diverticulitis Breakthrough Ebook Review

Highly Recommended

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Indications For Procedure

Indications for colectomy include benign and malignant diseases (Table 1). The most common benign conditions are diverticulitis, lower gastrointestinal (GI) hemorrhage, ulcerative colitis, sigmoid volvulus, and penetrating trauma. The most common malignant condition is adenocarcinoma of the colon. When colectomy is being considered for benign conditions many variables are considered prior to recommending surgery. For example, in cases of sigmoid diverticulitis or sigmoid volvulus, recurrence rates are important. After one episode of sigmoid diverticulitis, the risk of a second episode is about 15-20 . However, if a patient has a second episode, the risk of subsequent attacks of diverticulitis rises to about 50 . Therefore, most surgeons recommend elective segmental colectomy after resolution of a second episode.

Contraindications

Purely elective colon surgery for a benign condition could be postponed for long periods while medical issues are addressed. Conversely, a patient with a life-threatening colonic condition, e.g., perforated diverticulitis with generalized peritonitis may require urgent surgery despite the patient's fragile condition.

Disorders of the Large Intestine and Rectum

Diverticular Disease Diverticula are small bulges or pouches that develop in the colon. These pouches form when the colon strains to move hard stool, and the increased pressure pushes through weak spots in the lining of the colon. This condition may result from eating a diet that is low in fiber. If there are no symptoms or mild symptoms, the condition is called diverticulosis. If the pouches become infected or inflamed such as when stool or bacteria become trapped inside them the condition is known as diverticulitis. Diverticular disease occurs mainly in developed countries such as the United States, where people regularly consume low-fiber processed foods. Diverticulosis usually does not cause symptoms, although some people may experience tenderness or pain in the lower abdomen. Others may have mild cramps, bloating, and alternating bouts of constipation and diarrhea. Eating a well-balanced diet (see page 49) that is low in fat and high in fiber, taking fiber supplements, and taking...

Pathogensesis And Pathology

Actinomyces species are agents of low pathogenicity and require disruption of the mucosal barrier to cause disease. Actinomycosis usually occurs in immunocompetent persons but may afflict persons with diminished host defenses. Oral and cervicofacial diseases commonly are associated with dental caries and extractions, gingivitis and gingival trauma, infection in erupting secondary teeth, chronic tonsillitis, otitis or mastoiditis, diabetes mellitus, immunosuppression, malnutrition, and local tissue damage caused by surgery, neoplastic disease, or irradiation. Pulmonary infections usually arise after aspiration of oropharyngeal or gastrointestinal secretions. Gastrointestinal infection frequently follows loss of mucosal integrity, such as with surgery, appendicitis, diverticulitis, trauma, or foreign bodies (1). The use of intrauterine contraceptive devices (IUDs) was linked to the development of actinomycosis of the female genital tract. The presence of a foreign body in this setting...

History and Physical Examination

The focus initially should be to establish the quantity and color of blood and elicit any symptoms of hemodynamic instability that would require immediate intervention. The medical history can then evaluate previous GI bleeding episodes and diagnoses associated with recurrent episodes of bleeding. These include diverticulosis, angiodysplasias, hemorrhoids, ulcers, varices, or inflammatory bowel disease. Other important history findings include comorbid diseases, coagulopathies, liver disease, nonsteroidal antiinflammatory drug use (NSAID), and radiation therapy affecting the abdomen or rectum (prostate). NSAID use is a very important risk factor, now recognized as the cause of not only upper GI bleeding, but also increased lower GI bleeding.

Endoscopic Therapy

When diverticulosis is the cause of lower GI bleeding, it is not usually possible to identify a visible vessel or clot within a particular source diverticulum at the time of colonoscopy, but finding these lesions is useful because it may denote those patients at high risk for persistent or recurrent diverticular bleeding (50). Pathologic examination of resected specimens may show erosion of an artery into either the dome or the orifice of the diverticulum. The lesion, if seen, can be treated by the usual methods bipolar multipolar electrocautery, heater probe, or epi-nephrine injection, independently or together, for control of bleeding. Endoscopic placement of metallic clips can also provide hemostasis (51). Colonoscopic treatment may prevent recurrent bleeding and reduce the need for hemicolectomy (52). Massive diverticular bleeding may not be amenable to endoscopic therapy because of poor visualization of the colon. Radiographic or surgical therapy should be considered for...

Tigecycline Antibiotic [97103

Mechanism of action involves inhibiting protein translation in bacteria by binding to the 30S ribosomal subunit and blocking entry of amino-acyl tRNA molecules into the A site of the ribosome to effectively prevent incorporation of amino acid residues into elongating peptide chains. Presumably, ribosomal protection proteins are ineffective against tigecycline due to its higher affinity for ribosomal binding compared to tetracyclines (approximately 16-fold). In addition, tigecycline may be resistant to efflux mechanisms by either their inability to translocate it across the cytoplasmic membrane due to steric complications or simply by their failure to recognize the molecule. The essential glycylamido appendage, not found in any naturally occurring tetracycline and responsible for imparting certain microbiologic properties to tigecycline, is attached by reacting 9-amino-minocycline (derived from nitration of minocycline followed by reduction via catalytic hydrogenation) with...

Acute Lower Gastrointestinal Hemorrhage

Lower Bleed Diverticulitis

Lower GI hemorrhage accounts for 10 of all acute GI bleeding, with 70 occurring in patients older than 65 years (18). Although the origin of bleeding depends largely on the age of the patient and the rate of hemorrhage, the two most common causes of massive lower gastrointestinal hemorrhage are diverticular disease (Fig. 4) and angiodysplasias (Fig. 5) (Table 2) (9). Less common etiologies include ischemic colitis, neoplasms, Meckel's diverticulum, inflammatory bowel disease, postpolypectomy bleeding, and a wide range of AIDS-associated conditions such as Kaposi's sarcoma (Fig. 6), lymphoma, and cytomegalovirus ulcers (19,20). In adults, diverticular disease is the source of 30-40 of major lower GI hemorrhage (4,5,21,22). Although most episodes of diverticular hemorrhage cease spontaneously, up to 35 will require blood transfusion and 5 an emergent operation (23,24). Following the first episode of bleeding, there is a 25 chance of reoccurrence, and after two episodes of hemorrhage,...

Abdominal

This is a chronic, localized, inflammatory process that often occurs weeks, months, or years after the integrity of the gastrointestinal mucosa is broken by surgery for acute appendicitis with perforation, or for perforated colonic diverticulitis, or by emergency surgery on the lower intestinal tract after trauma. Occasionally, abdominal actinomycosis may manifest without identifiable predisposing factors. The ileocecal region is involved most frequently (usually following appendicitis with perforation), with the formation of a mass lesion. The infection extends slowly to contiguous organs, especially the liver, and may involve retroperitoneal tissues, the spine, or the abdominal wall. Hepatic, renal, and splenic disseminations are uncommon complications (5). Persistent draining sinuses may form, and those involving the perianal region can simulate Crohn's disease or tuberculosis. The extensive fibrosis of actinomycotic lesions, presenting to the examiner as a mass, often suggests...

Angiography

The overall yield of angiography is 40-78 (15). Diverticular disease and angiodysplasia are the most common findings (15-18). Other lesions include peptic ulcer, Meckel's diverticulum, neoplasm, and vascular-enteric fistula. Angiography may also define lesions with abnormal vasculature, such as vascular malformations or tumors, even if extravasation of contrast material is not noted. This is useful in patients with acute massive bleeding that has slowed by the time of angiography or in patients with chronic or recurrent bleeding in whom a diagnosis has been difficult to establish. A bleeding rate of 1 mL min during angiography is generally required for a positive result, much higher than that needed for scintigraphy (as low as 0.1 mL min) (19,20), although rates as low as 0.4 mL min have been detected.

Diverticula

Diverticulosis of the Colon Colonic diverticula are thought to be the most frequent cause of lower intestinal hemorrhage in the elderly, but the precise percentage is uncertain for several reasons. First, diverticula are very common in the general population older than age 50, with a prevalence increasing linearly with age and affecting most people by age 80. Second, proof of bleeding from any diverticulum is very difficult to establish by angiography or colonoscopy because the bleeding episodes last a very short time and are intermittent, and pathologic examination of resected colons in these patients does not often reveal evidence of arterial rupture into a diverticulum. Thus, the diagnosis is usually based simply on the presence of diverticulosis and the failure to identify other definite causes (36).

Surgery

Surgery is a consideration in patients with acute lower intestinal bleeding if the blood transfusion requirement is greater than 4 U within 24 hours, or when bleeding recurs (63). However, the decision to proceed depends on risks related to age and comorbid disease. Surgery is reserved for treatment of a defined site of hemorrhage, or for diagnostic purposes when combined with intraoperative endoscopy. Localization of the site of bleeding can help avoid extensive surgical intervention with blind total colectomy. Directed segmental resection (i.e., left hemicolectomy) can be considered in a patient with persistent or recurrent bleeding attributed only to diverticular disease limited to the left colon. Substantial risks of rebleeding and mortality are associated with blind limited resection or emergency total abdominal colectomy, particularly in elderly patients. If the results of thorough diagnostic studies are negative and the blood loss is self-limited or, if chronic, can be...

Timing Of Surgery

Another subset of patients are those who have their bleeding site localized by angiography and then their bleeding subsequently stops or is aided in its cessation by vasopressin or embolization. Some surgeons are proponents of nonoperative intervention at this point in the same way that a noncomplicated diverticulitis patient is allowed one episode, with surgery only recommended after a second attack. A rebleed rate of only 25 in all cases is cited in support of this opinion, even though the rebleed rate in this subgroup may be higher. Other surgeons, including the authors, disagree with that stance. Obviously, bleeding that can be localized by angiography is severe. A rebleed of this type would be life-threatening. Intervention at the time of the first bleed is therefore advised. Some may argue that vasopressin or embolization is adequate intervention, but the rebleed rate is significant, with an approximately 30 rebleed rate after successful vasopressin therapy (10-12) and a 25...

Blind Left Colectomy

Up until the 1950s, most lower GI bleeding was felt to be secondary to diverticulosis. Since the left colon was the predominant location of diverticula, surgeons supported segmental resection of the left colon in cases of persistent lower GI bleeding. This approach resulted in a high rebleeding rate of 30 (9,19), as well as a high mortality rate of20-40 (4,20-22). These poor results were largely because of the unrecognized right-sided angiodysplastic lesions as a common cause of lower GI bleeding. A shift occurred in the 1950s toward total abdominal colectomies for lower GI bleeding followed later by a shift to blind right colectomies, with the justification that most lower GI bleeds are from the right colon. Currently, a blind left colectomy for lower GI bleeding is discouraged, although some surgeons will selectively perform one based on intraoperative findings such as blood limited to the left colon. This obviously is not a foolproof method by which to make a decision and therefore...

Myositis

Spontaneous, nontraumatic gas gangrene is mostly due to C. septicum, which spreads by bacteremic route. Intestinal abnormalities that include necrotizing enterocolitis volvulus colon cancer diverticulitis and bowel infarction and leukemia, neutropenia, and diabetes mellitus are the major predisposing conditions. Psoas abscess generally develops as a result of spread from an adjacent structure, either as an extension of intra-abdominal infection (appendicitis, diverticulitis, Crohn's disease), perinephric abscess, or infected retroperitoneal hematoma. It can also originate from vertebral tuberculosis or S. aureus osteomyelitis. Osteomyelitis of the ilium or septic arthritis of the sacroiliac joint can produce iliacis or psoas abscess.

Epidemiology

The annual incidence of lower GI bleeding is much less (20.527 cases per 100,000 adult population at risk) and generally has a less severe course than upper GI bleeding (100-200 cases per 100,000). Age is the strongest risk factor for lower GI bleeding, with an approximately 200-fold increase in the elderly compared with young adults. This rise in incidence most likely represents the increasing prevalence of colonic diverticulosis and colonic angiodysplasia with age. The mean age of patients with lower GI bleeding ranges from 63 to 77 years, and