Diverticular disease: Pathology review
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Diverticular disease: Pathology review
Pathology
Peritoneum and peritoneal cavity
Peritonitis
Pneumoperitoneum
Upper gastrointestinal tract disorders
Cleft lip and palate
Congenital diaphragmatic hernia
Esophageal web
Tracheoesophageal fistula
Pyloric stenosis
Sialadenitis
Parotitis
Oral candidiasis
Ludwig angina
Aphthous ulcers
Temporomandibular joint dysfunction
Dental abscess
Gingivitis and periodontitis
Dental caries disease
Oral cancer
Warthin tumor
Barrett esophagus
Achalasia
Plummer-Vinson syndrome
Mallory-Weiss syndrome
Boerhaave syndrome
Gastroesophageal reflux disease (GERD)
Zenker diverticulum
Diffuse esophageal spasm
Esophageal cancer
Eosinophilic esophagitis (NORD)
Gastritis
Gastric dumping syndrome
Peptic ulcer
Gastroparesis
Cyclic vomiting syndrome
Gastroenteritis
Gastric cancer
Lower gastrointestinal tract disorders
Gastroschisis
Imperforate anus
Omphalocele
Meckel diverticulum
Intestinal atresia
Hirschsprung disease
Intestinal malrotation
Necrotizing enterocolitis
Intussusception
Tropical sprue
Small bowel bacterial overgrowth syndrome
Celiac disease
Short bowel syndrome (NORD)
Lactose intolerance
Whipple's disease
Protein losing enteropathy
Microscopic colitis
Crohn disease
Ulcerative colitis
Bowel obstruction
Intestinal adhesions
Volvulus
Gallstone ileus
Abdominal hernias
Femoral hernia
Inguinal hernia
Small bowel ischemia and infarction
Ischemic colitis
Familial adenomatous polyposis
Peutz-Jeghers syndrome
Gardner syndrome
Juvenile polyposis syndrome
Colorectal polyps
Colorectal cancer
Carcinoid syndrome
Irritable bowel syndrome
Gastroenteritis
Diverticulosis and diverticulitis
Appendicitis
Anal fissure
Anal fistula
Hemorrhoid
Rectal prolapse
Liver, gallbladder and pancreas disorders
Crigler-Najjar syndrome
Biliary atresia
Gilbert's syndrome
Dubin-Johnson syndrome
Rotor syndrome
Jaundice
Cirrhosis
Portal hypertension
Hepatic encephalopathy
Hemochromatosis
Wilson disease
Budd-Chiari syndrome
Non-alcoholic fatty liver disease
Cholestatic liver disease
Hepatocellular adenoma
Autoimmune hepatitis
Alcohol-induced liver disease
Alpha 1-antitrypsin deficiency
Primary biliary cirrhosis
Primary sclerosing cholangitis
Hepatitis
Neonatal hepatitis
Reye syndrome
Benign liver tumors
Hepatocellular carcinoma
Gallstones
Biliary colic
Acute cholecystitis
Ascending cholangitis
Chronic cholecystitis
Gallstone ileus
Gallbladder cancer
Cholangiocarcinoma
Acute pancreatitis
Pancreatic pseudocyst
Chronic pancreatitis
Pancreatic cancer
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Gastrointestinal system pathology review
Congenital gastrointestinal disorders: Pathology review
Esophageal disorders: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Malabsorption syndromes: Pathology review
Diverticular disease: Pathology review
Appendicitis: Pathology review
Gastrointestinal bleeding: Pathology review
Colorectal polyps and cancer: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
Pancreatitis: Pathology review
Gallbladder disorders: Pathology review
Jaundice: Pathology review
Viral hepatitis: Pathology review
Cirrhosis: Pathology review
Assessments
Diverticular disease: Pathology review
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Content Reviewers
Yifan Xiao, MDAt the gastroenterology clinic, there is a 62- year- old male from Germany, named Karl, who came in for his regular colonoscopy.
He is totally asymptomatic, except for occasional vague abdominal discomfort after meals.
Next, a 65- year- old Native American named James came to the emergency department after two episodes of painlessly passing fresh, red blood in his stool.
Finally, Zendaya, a 78- year- old African- American female, was brought to the hospital from a nursing home by paramedics, due to a severe pain in the left lower abdomen which started this morning.
Her temperature was measured at 101.8°F or 38.8°C at the nursing home.
On further history, they all had diets low in fiber and high in fat and red meat and suffered from chronic constipation.
Zendaya’s nursing home attendant reports that lately her constipation has been even worse than usual; in fact, her last bowel movement was more than three days ago.
Karl, James and Zendaya all have diverticula in the colon.
Diverticula are small outpouchings that form along the walls of a hollow structure, most commonly, the large intestine.
According to their pathogenesis, diverticula can be broadly grouped into traction and pulsion diverticula.
Traction diverticula occur due to the pulling forces of an adjacent inflammatory site, resulting in scarring and outpouching of all layers of the intestinal wall.
These are also known as true diverticula.
Next, there’s pulsion diverticula, which are a result of high pressures created during a strained bowel movement.
The pressure pushes on the mucosa and submucosa until they bubble out through weak spots along the wall, like where a blood vessel penetrates the muscle layer of the intestine.
These are also known as false or pseudodiverticula since they don’t involve all layers of the intestinal wall.
For your exams, it’s important to know that, most of the time, diverticula in the large intestine, and particularly, the left and sigmoid colon, are pulsion or false diverticula.
Sources
- "Fundamentals of Pathology" H.A. Sattar (2017)
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon" Alimentary Pharmacology & Therapeutics (2015)
- "Management of lower gastrointestinal tract bleeding" Best Practice & Research Clinical Gastroenterology (2008)
- "Diverticulosis and Diverticulitis" Mayo Clinic Proceedings (2016)
- "Etiology and Pathophysiology of Diverticular Disease" Clinics in Colon and Rectal Surgery (2004)
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