Doença de divertículos digestivos

　　Because the blood vessels in the upper part of the jejunum and the distal ileum are thicker, the muscular layer of the intestinal wall is fragile at these locations, especially in the upper part of the ileum. In addition, long-term intake of low-fiber foods causes a continuous increase in intraluminal pressure, which is more common in the elderly due to the weakening of the muscular strength of the intestinal wall. Although the specific cause of diverticulum formation is not yet known, most experts believe that the main cause is the pressure produced by the small hard feces produced by defecating low-fiber diet. The high pressure produced by the abnormal movement of the colon (possibly due to low fiber content in the diet) forces the intestinal endothelium to penetrate the weak points of the outer muscular layer of the colon.

　　Patients with gastrointestinal diverticulosis may have complications such as intestinal perforation, abscess, fistula, intestinal obstruction, massive hemorrhage, inflammation, perforation, and cancer within the diverticulum, which seriously endanger patients' health and threaten their lives. Therefore, timely treatment is essential.

　　1. Esophageal diverticula

　　1、Pharynx-Esophageal diverticula

　　Clinical manifestations include mild dysphagia, the food retained in the diverticulum can be regurgitated into the oral cavity, coughing is more likely to occur after meals and during sleep. In the late stage, there are symptoms such as laryngeal recurrent nerve compression causing hoarseness, gurgling sound when drinking water, and recurrent aspiration pneumonia. During physical examination, a dough-like mass can be found above the clavicle at the root of the neck, which emits a gurgling sound when pressed. Barium swallow X-ray film can clearly diagnose the disease. In cases where cancer develops in the diverticulum, early surgical treatment is required.

　　2、Mid-esophageal diverticula

　　Less common, it is a protruding true diverticulum caused by adhesion of the tracheal隆突下lymph nodes with tuberculosis or other inflammatory lesions to the anterior wall of the esophagus, pulling the entire esophageal layer. The opening of the diverticulum is large, the bag position is higher than the neck, and it is not easy to occur food retention. Generally, there are no symptoms, a few people have difficulty swallowing, and a very few occur mediastinal abscesses or esophageal tracheal fistulas. Symptomatic patients can be treated with water balloon or balloon dilation, and asymptomatic patients do not require surgical treatment.

　　3、Diverticula of the upper esophagus

　　The least common in esophageal diverticula, it belongs to a pseudodiverticulum located above the diaphragm at the lower segment of the esophagus10At cm, males are more common, often accompanied by esophageal spasm, cardia spasm, reflux esophagitis, or esophageal hiatus hernia. Diagnosis depends on X-ray examination, CT examination can differentiate mediastinal tumors, abscesses, or hiatus hernia. Patients without symptoms do not require treatment, those with obvious symptoms such as dysphagia, pain behind the sternum, and malignancy require surgical resection.

　　Second, gastric diverticulum

　　Most patients are asymptomatic, and a few report intermittent upper abdominal fullness or lower chest pain after meals or when lying flat, accompanied by nausea, vomiting, a burning sensation, and related to the retention of food in the diverticulum. Common complications are bleeding.

　　Third, small intestinal diverticulum

　　1Duodenal diverticulum

　　It is the most common type of small intestinal diverticulum. The vast majority of patients are asymptomatic, and about10Percentage of patients report upper abdominal discomfort and pain, accompanied by nausea and belching, which worsen after eating. When complications such as inflammation or ulcers occur, symptoms may be more severe or persistent. There may be tenderness at the site of the diverticulum, and there are about27Percentage of patients with cholelithiasis, which can also cause obstruction of the common bile duct, cholangitis, recurrent pancreatitis, and other complications are bleeding and perforation, which are not common. Bleeding can be caused by erosion of the diverticular mucosa or maldevelopment of blood vessels, or by penetrating the nearby mesenteric blood vessels, which can lead to the portal vein, bile duct, or pancreas, causing abscesses. Diverticula in the duodenal lumen can cause partial or complete duodenal obstruction, leading to postprandial upper abdominal fullness, sharp pain, vomiting after meals, and relief after vomiting.

　　2Meckel diverticulum

　　It is a true diverticulum located at the distal ileum, caused by incomplete closure of the ileal end of the yolk sac during embryogenesis. Most patients are asymptomatic, and symptoms appear when complications occur. When the diverticulum bulges into the intestinal lumen, it can cause intussusception and obstructive intestinal obstruction, with symptoms such as vomiting, abdominal distension, constipation, or red jam-like stools. The ectopic gastric mucosa can secrete hydrochloric acid and pepsin, causing diverticular peptic ulcers and hemorrhage, which are common complications in pediatric cases.

　　3Obtained small and large bowel diverticula

　　This disease is rare. Solitary diverticula often have no symptoms. When there is a large amount of bacterial proliferation in multiple diverticula, symptoms such as dyspepsia, such as abdominal pain, bloating, diarrhea, and malabsorption, may occur, and weight loss, anemia, and steatorrhea may appear. Small and large bowel diverticulosis is one of the common causes of malabsorption syndrome in the small intestine. Complications are rare, and they include acute inflammation, hemorrhage, perforation, small bowel obstruction, and cancer within the diverticula.

　　Four, colonic diverticula

　　Currently, there is chronic intermittent left lower abdominal pain, and the typical patient reports constipation accompanied by abdominal distension and dyspepsia. During physical examination, tenderness may be felt in the left lower abdomen, and the cecum may be palpated as hard and filled with feces.

　　Eat less of fruits with seeds or coarse fiber vegetables and spicy foods to avoid increasing peristalsis and worsening symptoms. During the acute phase, a liquid diet should be consumed to make the stool soft, reduce retention, and facilitate excretion through the diverticula. It can be taken before going to bed every night.5Do not perform colon lavage with 30 ml of liquid paraffin or senna tea, etc., to avoid perforation.

　　1Examination of the abdomen with flat film

　　A radiographic examination of the abdomen for solitary diverticulosis is usually normal and therefore of little value. The imaging features of diverticulitis are: displacement or narrowing of the intestinal wall, mucosal changes, and the presence of multiple diverticula in the intestinal segments near or far from the lesion. Abdominal flat film may reveal peritoneal abscess, multiple air-fluid levels and dilated intestinal tubes caused by small and large bowel obstruction.

　　2realizar a cefalografia por enema

　　O uso de bário ou contraste hidrossolúvel para enema tem grande valor para o diagnóstico de doença diverticular assintomática, é mais confiável do que o colonscopia, e as hérnias bariadas aparecem como protuberâncias esféricas que se projetam da parede do cólon, e as hérnias ainda podem ser vistas após a eliminação do bário, sem sinais de inflamação, o que pode ocultar as hérnias. Às vezes, o revolvimento do divertículo ou o acúmulo de fezes podem confundir-se com pólipos, portanto, é necessário observar e fotografar em várias direções, e fazer fotos após o esvaziamento para aumentar a precisão do diagnóstico.

　　Quais alimentos são bons para a saúde das pessoas com doença diverticular digestiva

　　1beber pelo menos6copos de água para prevenir a constipação. Se você já tem constipação, prunes, suco de prunes ou chás de ervas especiais para tratar a constipação podem ser usados como laxantes naturais.

　　2Mantenha uma dieta de baixa gordura, pois a gordura pode diminuir o tempo de passagem dos alimentos pelo intestino. Faça-Exames de sensibilidade a alimentos para encontrar alimentos que estimulem o sistema digestivo e evitar seu consumo.

　　3Experimente diariamente1-3Água ou suco de vegetais para restringir a dieta. Quando a inflamação e a sensibilidade das hérnias diverticulares ainda estão presentes, alimentos de baixa capacidade devem ser consumidos (sopas e dietas de baixa fibra). Durante a fase aguda da inflamação diverticular, deve-se aumentar a proporção desses alimentos na dieta: como vegetais cozidos, frutas cozidas e maçãs, esses alimentos podem lubrificar o intestino. Evitar leite e derivados de leite (iogurte e queijo), que podem agravar a doença, especialmente quando há diarreia.

　　As hérnias diverticulares assintomáticas não precisam de tratamento, enquanto as que têm sintomas e coexistem com outras doenças abdominais, o tratamento deve ser iniciado com as últimas. Se os sintomas forem de fato causados por hérnias, o tratamento deve ser abordado de maneira integrada, incluindo ajustes na dieta, antiácidos, relaxantes musculares e drenagem postural. A menos que haja complicações difíceis de controlar ou câncer, geralmente não se considera cirurgia. Especialmente quando a anatomia ao redor das hérnias é complexa, a cirurgia deve ser feita com cautela. A maioria das hérnias diverticulares sem complicações deve ser tratada conservadoramente, evitando alimentos ricos em fibra e alimentos irritantes para evitar aumentar a peristalse intestinal e agravar os sintomas. Durante a fase aguda, deve-se comer alimentos líquidos para tornar as fezes suaves, reduzir a constipação e facilitar a saída das fezes das hérnias. Pode-se tomar à noite, antes de dormir.5ml de parafina líquida ou chá de senna como substituto, não deve ser usado para enemas de cólon, a fim de evitar perfurações. Antibióticos podem ser usados para controlar infecções.