Difference between diverticulitis and colitis: Diverticulitis vs. Ulcerative Colitis (UC): Differences & Symptoms

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Difference Between Colitis and Diverticulitis

Key Difference – Colitis vs Diverticulitis

Colitis and diverticulitis are two inflammatory diseases of the colon that are difficult to be diagnosed solely based on the clinical features. The inflammation of the colon is known as colitis. Diverticulitis is the inflammation of the diverticula in the colon. As seen from the definitions, colitis is a condition that occurs in the colon whereas diverticulitis is a condition that takes place in the diverticula. This is the main difference between colitis and diverticulitis.

1. Overview and Key Difference
2. What is Colitis
3. What is Diverticulitis
4. Similarities Between Colitis and Diverticulitis
5. Side by Side Comparison – Colitis vs Diverticulitis in Tabular Form
6. Summary

What is Colitis?

The inflammation of the colon is known as colitis. Clinical features of this condition vary according to the underlying pathology.

Main Causes

Crohn’s Disease

Crohn’s disease is an inflammatory bowel disease characterized by the transmural inflammation of the colonic mucosa. Usually, only some regions of the colon are inflamed, giving rise to skip lesions rather than a continuous involvement.

Clinical Picture

Diarrhea

Diarrhea in Crohn’s disease is due to the excessive secretion of the fluids and the impaired absorption of fluids by the inflamed bowel mucosa. In addition, the malabsorption of bile salts by the inflamed terminal ileum also contributes to the aggravation of diarrhea.

Fibrostenotic Disease

The obstruction of the gastrointestinal tract due to small bowel strictures or colonic strictures can give rise to symptoms such as abdominal pain, constipation, nausea, and vomiting.

Fistulizing Disease

The transmural inflammation of the GIT can be the cause of sinus tracts, serosal penetration, and fistulae such as enteroenteric fistulae. The penetration of the bowel by the inflammatory lesions leads to the leakage of colonic substances into the peritoneal cavity, resulting in peritonitis and other associated complications.

Local complications of Crohn’s disease

Watery diarrhea due to the stimulatory effects on colonic water and electrolyte absorption
The reduced concentration of bile acids interrupts the absorption of fat thus resulting in steatorrhea
Long-term steatorrhea can lead to osteoporosis, malnutrition and clotting abnormalities
Formation of gallstones
Nephrolithiasis (formation of kidney stones)
Vitamin B12 malabsorption

Crohn’s disease increases the risk of colon cancers, lymphomas and squamous cell carcinomas of the anus.

Morphology

Mostly the right side of the colon is affected by the Crohn’s disease. There is a segmental distribution of the lesions. Usually, the rectum is spared.

There is a transmural involvement with the occurrence of fissures and noncaseating granulomas.

Diagnosis

The clinical history and examination play a vital role in the diagnosis of CD.

Endoscopy reveals the presence of the presence of aphthous ulcers that give rise to a cobblestone appearance. Abdominal and pelvic scanning can be used to identify any abscesses.

Management

There is no definite cure for the Crohn’s disease. The aim of treatment is the suppression of inflammatory processes that give rise to the clinically manifested signs and symptoms.

Anti-inflammatory drugs – Corticosteroids such as prednisolone and Aminosalicylates
Immune system suppressors such as azathioprine and biological agents such as infliximab
Antibiotics
Analgesics
Antidiarrheals
Iron and vitamin B12 supplements

In some cases, surgical removal of the damaged parts of the colon is required.

Ulcerative Colitis

Ulcerative colitis is an inflammatory disease of the rectum extending proximally to variable distance. Women are more likely to be affected by this condition than men.

Clinical Features

Blood and mucus diarrhea
Cramp-like abdominal pain
Per rectal bleeding
In some cases, there can be toxemia, fever and severe bleeding.

Investigations

Sigmoidoscopy
Colonoscopy
Barium enema
Examination of the stools reveals the presence of blood and pus
Figure 01: Histopathological image of the active stage of ulcerative colitis

Complications

Local complications

Toxic dilatation
Hemorrhage
Stricture
Malignant changes
Perianal diseases such as anal fissures and anal fistulae.

General Complications

Toxemia
Anemia
Weight loss
Arthritis and uveitis
Dermatological manifestations such as pyoderma gangrenosum
Primary sclerosing cholangitis

Management

Medical Management

A high protein diet with vitamin supplements and iron is prescribed. Blood transfusion may be required if the patient shows clinical signs of severe anemia. Loperamide is usually given to control diarrhea. The administration of corticosteroids as per rectal infusions induces remission in an acute attack. Immunosuppressors such as infliximab are required to control more severe attacks of ulcerative colitis.

Surgical Management

Surgical intervention is indicated only in the following situations.

Fulminating disease not responding to medical treatments
Chronic disease not responding to medical treatments
Prophylaxis against malignant changes
In the occasions where the patient presents with the complications mentioned above.

What is Diverticulitis?

Diverticulitis is the inflammation of the diverticula in the colon. These diverticula can be of either congenital or acquired origin.

An inflamed diverticulum can give rise to the following complications.

The diverticulum can perforate into the peritoneum resulting in peritonitis. Pericolic abscesses can be formed if it penetrates the pericolic tissues. Its perforation into any other adjacent structure is most likely to end up with the occurrence of fistula.
The chronic inflammation associated with diverticulitis leads to fibrosis of the inflamed tissues giving rise to obstructive symptoms such as constipation.
The erosion into blood vessels results in internal hemorrhages.

Clinical Features

Acute Diverticulitis

This condition is known as the left-sided appendicitis because of the characteristic pain of acute onset that originates in the low central region of the abdomen and gradually shifts to the left iliac fossa. There can be other nonspecific symptoms such as nausea, vomiting, and local tenderness.

Chronic Diverticular Disease

This mimics the clinical features of a colonic carcinoma.

Change in bowel habits
Vomiting, abdominal bloating, colicky abdominal pain, and constipation due to the obstruction of the large bowel.
Blood and mucus per rectum

Investigations

CT is the most appropriate investigation to identify diverticulitis in its acute stage by excluding other possible diagnoses.
Sigmoidoscopy
Colonoscopy
Barium enema

Figure 02: Intraoperative view of sigma diverticulum

Treatment

Acute Diverticulitis:

Conservative management is recommended for treating a patient diagnosed with acute diverticulitis. The patient is kept on a fluid diet and antibiotics such as metronidazole and ciprofloxacin.

Pericolic abscesses are diagnosed by CT. Percutaneous drainage of these abscesses is essential to avoid any future complications.
In case of a ruptured abscess giving rise to peritonitis, the pus should be removed from the peritoneal cavity by laparoscopic lavage and drainage.
When there is a diverticulitis associated obstruction in the colon, laparotomy is required to establish the diagnosis.

Chronic Diverticular Disease

This condition is managed conservatively if the symptoms are mild and the diagnosis has been confirmed through investigations. Usually, a lubricant laxative and high fiber containing diet are prescribed. When the symptoms are severe, and the possibility of a colonic carcinoma cannot be excluded, laparotomy and resection of the sigmoid colon are carried out.

What are the Similarities Between Colitis and Diverticulitis?

Both are inflammatory processes.
Abdominal pain is observed as a clinical symptom in both conditions.

What is the Difference Between Colitis and Diverticulitis?

Colitis vs Diverticulitis
The inflammation of the colon is known as colitis.	The inflammation of the diverticula in the colon is known as diverticulitis.
Location
This occurs in the colon.	This occurs in the diverticula.

Summary – Colitis vs Diverticulitis

Diverticulitis is the inflammation of the diverticula in the colon. The inflammation of the colon is known as colitis. The main difference between colitis and diverticulitis is that they occur in two separate sites.

Download PDF Version of Colitis vs Diverticulitis

You can download PDF version of this article and use it for offline purposes as per citation note. Please download PDF version here Difference Between Colitis and Diverticulitis

References:

1. Ellis, Harold, et al. General Surgery: Lecture notes. Chichester, Wiley, 2011.

Image Courtesy:

1.”Ulcerative colitis (2) endoscopic biopsy” By User:KGH – Own work (CC BY-SA 3.0) via Commons Wikimedia
2.”Intraoperative view of sigmoid diverticulitis” By Anpol42 – Own work (CC BY-SA 4.0) via Commons Wikimedia

Diverticulosis and Diverticulitis: What’s the Difference?

It’s easy to get the care you need.

See a Premier Physician Network provider near you.

Chances are, you don’t think much about your digestive tract — unless it’s giving you trouble.

A condition called diverticulosis, which is not uncommon for women over 50 (though men are at greater risk), can lead to trouble. With this condition, small pouches — diverticula — form in the colon (or intestinal) wall. And this can increase your risk of a painful bout of diverticulitis — an infection or inflammation of the pouches.

The good news? “Only a small number of people with diverticulosis have diverticulitis,” says Fayez Abboud, MD, gastroenterologist with Premier Gastroenterology Specialists.

Dr. Fayez Abboud talks about diverticulitis.

Click play to watch the video or read video transcript.

Diverticulitis is when some of the people with diverticulosis develop infections or an inflammation in these little sacs that protrude out. Only a small number of people with diverticulosis have diverticulitis.

The symptoms of diverticulitis are usually abdominal pain. Usually in the left, lower part of the abdomen. Pain, sometimes you can have fever, and tenderness; which means if you push on the abdomen you have pain with the pushing on it. These are the most common symptoms.

If it becomes very severe then it requires putting the patient in the hospital for treatment. The diverticulitis can become perforated, which is … Only a small number of people with diverticulitis have perforation, which is a serious condition where there’s a small little hole or a tear in one of these little sacs that leaks the contents of the bowel into the abdomen. That is a serious condition that usually requires surgery.

Diverticulitis, most cases of diverticulitis are acute. It’s a sudden attack, the patients know about it. But a small number of patients have recurrent, acute diverticulitis. They have recurrent episodes of these attacks. A small number of them can develop chronic diverticular disease, which is kind of a low grade degree of diverticulitis with some mild and chronic low grade discomfort. So it is possible for diverticulitis to become chronic to some extent.

Learn more about the link between the two, and what you can do when symptoms signal that something is wrong.

What Causes Diverticulitis and Diverticulosis?

Experts don’t know for sure what causes these conditions, but several factors may play a role:

High pressure in the colon: Muscle spasms in the colon or straining to have a bowel movement may cause bulges to form at weak spots.
Family history: The genes you inherit may make you more likely to develop diverticulosis and diverticulitis.
Medications: Studies have uncovered connections between these digestive conditions and some medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin.
Lifestyle: Lack of exercise, obesity and smoking may also contribute.

Dr. Fayez Abboud talks about what causes diverticulitis.

Click play to watch the video or read video transcript.

What causes diverticulitis? It’s not completely clear, but it is an infection and/or inflammation in one of the pockets. It is a common misconception that people are told to avoid seeds, or that people are told to avoid seeds, nuts, popcorn. Really the studies show that there is no clear evidence that avoiding these lead to diverticulitis.

What Are the Symptoms?

Diverticulosis: Most people with diverticulosis don’t even know they have it. But if you do have symptoms, they may include:

Bloating
Constipation
Cramping or pain in your lower abdomen

Diverticulitis: With diverticulitis, the inflamed pouches typically trigger pain in the lower left side of your abdomen. The pain is often severe and comes on suddenly. Other symptoms include:

Constipation or diarrhea
Fevers and chills
Nausea or vomiting

See your doctor right away if you are troubled by any of these symptoms.

With diverticulitis, the inflamed pouches typically trigger pain in the lower left side of your abdomen. The pain is often severe and comes on suddenly.

How Are Diverticulitis and Diverticulosis Diagnosed?

If your health care provider believes you have one or both conditions, based on your symptoms, she may make her diagnosis using the following:

Medical history: Your doctor will ask about your bowel movement frequency, diet, overall health, what medicines you take and what symptoms you are experiencing.
Physical exam: Your doctor will perform an exam, which may include a digital rectal exam, when she slides a gloved, lubricated finger into your anus to check for pain, bleeding, hemorrhoids or other problems.

Your doctor may also use one of these tests:

CT scan: This uses computer technology to combine multiple X-rays into a detailed image of your gastrointestinal (GI) tract.
Barium enema: A chalky, liquid solution of barium sulfate, introduced by enema, coats the large intestine to help provide clear X-ray images of your large intestine. This procedure is also called a lower GI series.
Colonoscopy: Using a thin, flexible tube with a tiny camera on the end, this test provides a look inside your rectum and colon.

Dr. Fayez Abboud talks about diagnosing and treating diverticulitis.

Click play to watch the video or read video transcript.

Diverticulitis is usually diagnosed by, initially, the clinical picture. People presenting with symptoms to suggest it. The examination, when we feel the abdomen and it’s tender where the diverticulosis is usually present. A CT scan of the abdomen usually confirms this diagnosis.

If somebody gets an acute diverticulitis every two or three years it can be treated with antibiotics. Having frequent attacks of diverticulitis can lead to complications, adhesions. Things stick together in the abdomen and then you can have something called “fistula,” when you develop an abnormal connection between the colon and the bladder or other organs.

How Are Diverticulitis and Diverticulosis Treated?

Diverticulosis: With the goal of preventing bothersome symptoms or more serious problems like diverticulitis, these can help:

High-fiber diet: Foods rich in fiber can help you avoid symptoms if you already have the condition. Increase fiber in your diet slowly to decrease the chances of abdominal gas and pain.
Medicines: Mesalazine (Asacol) and the antibiotic rifaximin (Xifaxan) may help reduce symptoms.
Probiotics: Probiotics are healthy bacteria, like those that naturally live in your stomach and intestines. You can find them in dietary supplements and in foods like yogurt. Talk with your doctor or health care provider first about using these or any alternative medicines.

Diverticulitis: Treatment will depend on your symptoms.

Mild symptoms: You may be put on a liquid diet for a short time. Antibiotics are often prescribed. If these help, your doctor may put you on a high-fiber diet.
Severe symptoms: You may be admitted to the hospital, where you can be given intravenous (IV) antibiotics and fluids. You will also be put on a low-fiber or liquid diet. In rare cases, surgery may be needed.

It’s easy to get the care you need.

See a Premier Physician Network provider near you.

Source: National Institutes of Health; American College of Gastroenterology; International Foundation for Functional Gastrointestinal Orders; Fayez Abboud, MD, Premier Gastroenterology Specialists

A comparison of diverticulitis in Crohn’s disease versus ulcerative colitis – Persaud – 2019 – JGH Open

Introduction

Inflammatory bowel disease (IBD) and diverticulitis are both inflammatory conditions of the bowel that lead to increased morbidity and mortality in patients. In industrialized regions, diverticular disease is a relatively common condition, with a prevalence ranging from 7 to 45%, but predominantly occurs in those older than 60 years of age.1-3 Moreover, a nationwide study in the United States showed a 26% increase in hospital admissions from 1998 to 2005 due to diverticular disease.4 Diverticulosis occurs where the vasa recta enters the muscle layer of the colon, leading to mucosal herniation through areas of colonic weakness.5 Diverticulitis ensues when a diverticulum undergoes micro or macroscopic perforations, leading to inflammation, usually as a result of increased intraluminal pressures.1, 6

Crohn’s disease (CD) is characterized by transmural inflammation that can involve any part of the gastrointestinal tract.7, 8 In contrast, ulcerative colitis (UC) is characterized by mucosal layer inflammation that occurs from the rectum and can extend proximally through the colon in a contiguous manner. Perianal disease and endoscopic examination of cobble-stoning, aphthous ulcerations, and biopsies showing granulomas, usually differentiate diverticulitis from CD.8, 9 However, segmental colitis associated with diverticula (SCAD), described in the literature as inflammation in the interdiverticular mucosa without involving the orifices, has been occasionally associated with both UC and CD.10, 11

Interestingly, a prospective study showed that the prevalence of diverticular disease in UC was found to be lower than controls.12 On the other hand, CD has been associated with a higher incidence of diverticulitis than would be expected in a population with non-IBD diverticular disease.8, 13

Moreover, each of these conditions is associated with a substantial financial burden. For example, hospitalization for UC is estimated to be between $19 000 and $29 000, depending on the severity of illness,14 while treatment of CD flares typically costs closer to $25 000, contingent on the need for surgery.15 In addition, the average cost of diverticulitis hospitalization has been estimated to be around $5000.16 This study aims to evaluate whether hospitalization outcomes differ for patients with acute diverticulitis and a history of CD compared to UC.

Methods

Data source

The national in-patient sample (NIS) represents 20% of all nonfederal hospitals in the United States. This large database was queried for demographic information of the population admitted for acute diverticulitis using the International Classification of Diseases-Ninth Edition Revision-Clinical Modification (ICD-9 CM). The NIS is a product of the Agency for Healthcare Research and Quality and contains patient information that has been deidentified. This is a nationally representative subset acquired through hospital discharge records and is the largest in-patient database currently available in the United States. While a proportion of the national population has been sampled, yearly sampling weights are applied, which then provide national estimates.17 Years of data and a multitude of works have verified the value of this sampling tool, and thus, it has been utilized for this study.

Study design and inclusion criteria

This is a cross-sectional study and includes all patients ≥ 18 years old with a primary diagnosis of acute diverticulitis in 2014. The ICD-9 CM codes used were 56 211, 56 201, 56 213, and 56 203. The database was then queried to include all patients with prior diagnosis of CD (5559, 555, 5550, 5551) or UC (5569, 556, 5568, 5565, 5566). Patients included in the study were required to have a primary diagnosis of acute diverticulitis with a prior diagnosis of either UC or CD. Primary study outcomes included mortality, cost of hospitalization, and length of stay (LOS) for diverticulitis with either UC or CD. A second comparison was made between those with CD and those without IBD. Various patient demographics (age, race, gender, income, and insurance status), comorbidities, and hospital characteristics (region and size) were obtained. The severity of the co-morbidities was analyzed via the Deyo modification of the Charlson comorbidity index (CCI). This index measures 17 common medical conditions and assigns different weights to compile a score from 0 to 33, which correlates with overall severity of illness.

Statistical analysis

Stata IC version 13 (StataCorp LP, College Station, TX, USA) was used for all statistical analyses. Specifically, the svy suite of commands was the extension package that was utilized. Categorical variables were analyzed with the χ² test, while continuous variables were analyzed with the adjusted Wald’s test. Hypothesis testing was two-sided. A multivariate logistic regression model was designed to investigate the association between acute diverticulitis and either UC or CD. The hierarchal model included both hospital-level characteristics (hospital teaching status, bed size, region) and patient-level characteristics (age, race, gender, comorbidities) and the CCI. To eliminate the effect of confounders, this was the primary means by which adjustments were made in the data for patient- and hospital-level characteristics. Univariate analysis was first conducted on all of the above factors and comorbidities that could affect diverticulitis hospitalization. Age, race, hospital location, hospital teaching status, and CCI were included in the final multivariate logistic regression model as P < 0.05, indicating statistical significance on univariate analysis. In the second comparison, between those with CD and those without IBD, age, gender, race, hospital location, hospital region, hospital size, CCI, diabetes mellitus type 2, congestive heart failure, chronic lung disease, and renal failure were included in the final multivariate logistic regression model as P < 0.05 was statistically significant on univariate analysis.

Ethical considerations

The data in the NIS are publicly available, and as a retrospective study, no patients were actively involved in the data collection process. Thus, it was not subject to Institutional Review Board approval, and informed consent was not needed.18

Results

In this study, we examined the population of those hospitalized for acute diverticulitis with prior diagnosis of IBD. There were 1815 patients meeting inclusion criteria, and 60% had CD, as shown in Table 1. The populations were largely similar in terms of age (60 ± 1.06 years old in CD vs 65 ± 1.32 years old in UC, P = 0.0), were predominantly female (57% in CD vs 67% in UC, P = 0.08), and were primarily Caucasian (87% in CD vs 84% in UC, P = 0.70). Comparing CD to UC, comorbidities that were most prevalent include hypertension (55% vs 55%, P = 0.98), followed by chronic obstructive pulmonary disease (20.64% vs 15.86%, P = 0.25), end-stage renal disease (8.72% vs 6.21%, P = 0.38), and congestive heart failure (5.96% vs 7.59%, P = 0.54). Among the two cohorts, there were no statistically significant differences with regard to comorbidities.

Table 1.
Unadjusted baseline characteristics of diverticulitis in Crohn’s disease versus ulcerative colitis

Variable	Crohn’s disease (n = 1090)	Ulcerative colitis (n = 725)	P value
Age (SEM)	59.59 (1.06)	65.3 (1.32)	0
Female (%)	8251 (57)	486 (67)	0.08
Race			0.7
Caucasian (%)	943 (86.5)	607 (83.7)
Black (%)	65 (5.97)	20 (2.76)
Hispanic (%)	60 (5.47)	57 (7.86)
Asian (%)	6 (0.5)	41 (5.66)
Other (%)	16 (1.5)	0%
COPD (%)	225 (20.64)	109 (15.86)	0.25
ESRD (%)	95 (8.72)	45 (6.21)	0.38
CHF (%)	65 (5.96)	55 (7.59)	0.54
Liver Disease (%)	55 (5.05)	10 (1.38)	0.07
DMcx (%)	25 (2.29)	10 (1.38)	0.53
HTN (%)	600 (55.05)	400 (55.17)	0.98
CCI (%)			0.88
0	652 (59.82)	405 (55.86)
1	198 (18.8)	160 (22.07)
2	135 (12.4)	85 (11.72)
3	105 (9.63)	75 (10.34)
Hospital size			0.3
Small (%)	61 (5.56)	58 (8.01)
Medium (%)	61 (5.56)	139 (19.20)
Large (%)	968 (88.9)	528 (72.8)
Hospital region			0.71
Northeast (%)	225 (20.64)	175 (24.14)
Midwest (%)	250 (22.94)	165 (22.76)
South (%)	460 (42.2)	265 (36.55)
West (%)	155 (14.22)	120 (16.55)
Insurance			0.06
Northeast (%)	473 (43.4)	373 (51.45)
Midwest (%)	93 (8.49)	68 (9.42)
South (%)	427 (39.15)	266 (36.70)
West (%)	97 (8.90)	18 (2.48)
Income			0.3
Medicare (%)	253 (23.20)	153 (21.13)
Medicaid (%)	289 (26.51)	255 (35.20)
Private insurance (%)	310 (28.44)	158 (21.83)
Self-pay (%)	238 (21.8)	159 (21.93)

Values are % except for age (mean + standard error mean).
CCI, Charlson comorbidity index; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DMcx, complicated diabetes mellitus type 2; ESRD, end-stage renal disease; HTN, hypertension.

However, hospital measures showed that UC incurred a much heavier hospitalization burden, as seen in Table 2. LOS in the UC cohort was markedly increased compared to the CD cohort (6.4 ± 0.53 days vs 4.7 ± 0.24 days, P = < 0.00), while the cost of hospitalization proportionally rose in the UC cohort compared to the CD cohort ($51 923 ± $6615 vs $36 140 ± $2245, P = 0.02). There were also 20 colectomies documented in the UC cohort, while none were documented in the CD cohort. Age, race, hospital location, hospital teaching status, and CCI were included in the logistic regression model, which confirmed that CD was associated with a decrease in the cost (OR −15 783, 95% CI −29 475 to −2091, P = 0.02; aOR −14 537, 95% CI −27 316 to −1758, P = 0.03) and LOS (OR −1.70, 95% CI −2.85 to −0.55, P = 0.37; aOR −1.31, 95% CI −2.41 to −0.21, P = 0.02) of hospitalization (Table 3). Moreover, there was an observed difference in mortality comparing CD to UC (OR 0.44, 95% CI 0.07 to 2.66, P = 0.37; aOR 0.90, 95% CI 0.10 to 7.87, P = 0.92), although this was not statistically significant.

Table 2.
Hospital outcome measures

Outcome	Ulcerative colitis	Crohn’s disease	No IBD	P value (CD vs UC)	P value (CD vs No IBD)
Died (%)	15 (2.1)	10 (0.9)	914 (0.42)
Mean LOS (SEM)	6.4 (0.53)	4.73 (0.24)	4.70 (0.03)	<0.00	0.9
Cost of hospitalization (SEM)	$51 923 ($6615)	$36 140 ($2245)	$38 793 ($442)	0.02	0.28
Colectomy (%)	20 (2.8)	0	985 (0.45)

Mean reported ± SEM.
CD, Crohn’s disease; IBD, inflammatory bowel disease; LOS, length of stay; UC, ulcerative colitis.

Table 3.
Effect of Crohn’s disease versus ulcerative on diverticulitis hospitalization

	Unadjusted odds ratio	95% CI	P value	Adjusted odds ratio	95% CI	P value
Died	0.44	0.07 to 2.66	0.37	0.90	0.102 to 7.87	0.92
Length of stay (days)	−1.70	−2.85 to −0.55	<0.00	−1.31	−2.41 to −0.21	0.02
Cost of hospitalization	−15 783	−29 475 to −2091	0.02	−14 537	−27 316 to −1758	0.03

An additional analysis was conducted with acute diverticulitis but comparing CD to the population without IBD. There were 219 815 patients in this cohort, with a median age of 60 ± 1.06 years in CD versus 60.4 ± 0.09 years without IBD (P = 0.41), with Caucasian prevalence (87% in CD vs 77% without IBD, P = 0.70) and slight female predominance (57% in CD vs 58% without IBD, P = 0.73). As in the previous cohort, the most common comorbidities are hypertension (55% in CD vs 54% without IBD, P = 0.67), chronic obstructive pulmonary disease (21% in CD vs 16% without IBD, P = 0.09), and end-stage renal disease (8.7% in CD vs 7% without IBD, P = 0.31) (Table 4). In terms of hospital measures, there was an interesting contrast to the prior set of hospital outcomes. Comparing the population with CD to those without IBD, there was negligible difference between the mortality rates (0.9% vs 0.42%), and both the hospital LOS (4.73 ± 0.24 days vs 4.70 ± 0.03 days, P = 0.90) and the cost of hospitalization ($36 140 ± $2245 vs $38 793 ± $442, P = 0.28) were nearly identical (Table 2). Between the cohort with CD and those without IBD, multivariate logistic regression also reflected these findings, showing no difference in mortality (OR 2.22, 95% CI 0.55 to 9.05, P = 0.26; aOR 2.47, 95% CI 0.59 to 10.36, P = 0.22), LOS (OR 0.03, 95% CI −0.45 to 0.51; P = 0.90; aOR 0.03, 95% CI −0.47 to 0.54, P = 0.91), and cost of admission (OR −2438, 95% CI −6865 to 1989, P = 0.28; aOR −2196, 95% CI −6933 to 2539, P = 0.36) (Table 5).

Table 4.
Unadjusted baseline characteristics of diverticulitis in Crohn’s disease versus absence of IBD

Variable	Crohn’s disease (n = 1090)	No IBD (n = 218 725)	P value
Age (SEM)	59.59 (1.06)	60.4 (0.09)	0.41
Female (%)	8251 (57)	126 860 (58)	0.73
Race
Caucasian (%)	943 (86.5)	168 200 (76.9)	0.7
Black (%)	65 (5.97)	18 592 (8.5)
Hispanic (%)	60 (5.47)	24 060 (11)
Asian (%)	6 (0.5)	2056 (0.94)
Other (%)	16 (1.5)	787 (0.36)
COPD (%)	225 (20.64)	35 280 (16.13)	0.09
ESRD (%)	95 (8.72)	15 376 (7.03)	0.31
CHF (%)	65 (5.96)	10 914 (4.99)	0.49
Liver Disease (%)	55 (5.05)	7, 655 (3.5)	0.2
DMcx (%)	25 (2.29)	3981 (1.82)	0.6
HTN (%)	600 (55.05)	117, 324 (53.64)	0.67
CCI (%)			0.23
0	652 (59.82)	130 119 (59.5)
1	198 (18.8)	49 125 (22.46)
2	135 (12.4)	20 035 (9.15)
3	105 (9.63)	19 446 (8.89)
Hospital size			0.34
Small (%)	61 (5.56)	48 607 (22.22)
Medium (%)	61 (5.56)	70 305 (32.14)
Large (%)	968 (88.9)	99 811 (45.63)
Hospital region			0.75
Northeast (%)	225 (20.64)	47 748 (21.83)
Midwest (%)	250 (22.94)	49, 738 (22.74)
South (%)	460 (42.2)	85 390 (39.04)
West (%)	155 (14.22)	35 849 (16.39)
Insurance			0.06
Northeast (%)	473 (43.4)	93 439 (42.7)
Midwest (%)	93 (8.49)	20 691 (9.46)
South (%)	427 (39.15)	93 898 (42.93)
West (%)	97 (8.90)	10 697 (4.89)
Income			0.62
Medicare (%)	253 (23.20)	54 134 (24.75)
Medicaid (%)	289 (26.51)	60 368 (27.60)
Private insurance (%)	310 (28.44)	53 216 (24.33)
Self-pay (%)	238 (21.8)	51 007 (23.32)

Values are % except for age (mean + standard error mean).
CCI, Charlson comorbidity index; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DMcx, complicated diabetes mellitus type 2; ESRD, end stage renal disease; HTN, hypertension; IBD, inflammatory bowel disease.

Table 5.
Effect of Crohn’s disease versus absence of IBD on diverticulitis hospitalization

	Unadjusted odds ratio	95% CI	P value	Adjusted odds ratio	95% CI	P value
Died	2.22	0.55 to 9.05	0.26	2.47	0.59 to 10.36	0.22
Length of stay	0.03	−0.45 to 0.51	0.90	0.03	−0.47 to 0.54	0.91
Cost of hospitalization	−2438	−6865 to 1989	0.28	−2196	−6933 to 2539	0.36

CI, confidence interval; IBD, inflammatory bowel disease.

Discussion

Diverticula typically present around the sigmoid colon, and when this is accompanied by left-sided IBD, the conditions may coexist.8 Patients can have a history of IBD with subsequent development of diverticulitis, as well as a history of IBD with induction of inflammation in asymptomatic diverticula.11, 19 However, the hospital burden of diverticulitis with pre-existing IBD has not been previously reported. There were 1815 patients admitted nationally for acute diverticulitis with pre-existing IBD in 2014. There were 33.5% more admissions for CD compared to UC, which is consistent with trends in the literature.8, 12, 13 Mucosal scarring in some UC patients may reduce the ability to form diverticula and could account for the decreased frequency of diverticulitis seen in the study.20 With regard to baseline characteristics, age was significantly different, while female gender and race were similar between the cohorts (Table 1).

Interestingly, there was a 26.5% increase in median LOS and 30.4% increase in cost of hospitalization with UC compared to CD. In addition, there were 50% more deaths with UC versus CD, which may be a result of emergent surgery.11 Overall, UC compared to CD was also associated with worse hospitalization outcomes on multivariate logistic regression. However, there was no significant difference in mortality.

Of the IBD subtypes, CD appears to have the more favorable hospitalization profile. Moreover, despite having 30% fewer patients, the UC cohort had 20 colectomies performed, with a longer and costlier hospital course. The CCI indicates that UC patients are not inherently more ill, and the outcome of this hospitalization is a result of events that occur during the course of the admission. Thus, the colectomies may be a reasonable explanation for the hospital measures seen above as mortality is typically higher in these patients.11 However, whether these surgeries occurred as a result of severe diverticular disease or UC warrants further investigation as it cannot be determined with the NIS database.

Given the above findings, an alternate analysis was conducted to compare CD hospitalization to the absence of IBD. Despite having 200× more patients, the population without IBD exhibited no significant difference among the LOS or cost of hospitalization. Multivariate logistic regression reflected these outcomes, demonstrating no association between the cohorts and increased mortality or hospitalization burden. There were colectomies performed in 0.5% of the population without IBD, so if this factor contributed to worsened hospitalization outcomes, it did not make as considerable an impact as in the UC cohort.

This is a meaningful study as hospitalization burden with these conditions is quite substantial14-16 and may differ based on the type of IBD involved. In this work, diverticulitis with simultaneous UC had a greater financial debt compared to a similar cohort with either CD or the complete absence of IBD. Colectomies, performed for severe manifestations of disease, likely have a prominent role in these outcomes. As colectomy is a known treatment in UC, its use as therapy may understandably prolong hospitalization. While it is possible that colectomies were also performed for severe diverticular disease, this information cannot be gathered from these data. It is important to note that the expensive and prolonged hospital course associated with this phenomenon has not been previously investigated in the literature. As such, the utility of this work is twofold: to raise awareness of conditions that may necessitate a higher level of care and the subsequent implications such a study will yield for resource management in hospitals.

The NIS has several strengths and limitations that warrant consideration. With health-related information from 20% of nonfederal hospitals, NIS has amassed a database that enables a representative study of the US population. These sample sizes are typically larger than hospital-funded studies; thus, the trends observed are difficult to dispute and provide a national overview of disease. However, NIS is an administrative database that is susceptible to coding inaccuracies.14 Indeed, the database is limited to those conditions that possess an ICD-9 code. Without this, there is no definitive way to identify a condition (i.e. Segmental Colitis Associated Disease, SCAD). Moreover, as laboratory values, imaging, and histology are not available, verification of the aforementioned conditions is not possible with this database (i.e. SCAD vs diverticular colitis). Thus, if the World Health Organization originally coded a condition as UC or diverticular colitis, the authors assumed it was an accurate characterization. In addition, the indications for a procedure are not supplied by NIS. Moreover, while multivariate logistic regression did account for most confounders (listed in the methods), there is a possibility that residual confounding still exists. Finally, this database is not designed to determine risk factors or causation. Thus, prospective trials will be necessary to further explore all possible etiologies and clinical applications of these findings.

Conclusions

In this national study, acute diverticulitis was examined with pre-existing IBD to determine if a difference in hospital outcome exists between UC and CD. There was a greater hospital burden observed in those with UC, which may be attributable to the colectomies that were performed. Moreover, there was a similar hospital burden among both those with CD and those without IBD, although for the latter, colectomies did not comprise as significant a proportion as for UC. The hospitalization outcomes of diverticulitis with concurrent IBD has not been presented in the literature, and this knowledge will assist clinicians in recognizing patients at higher risk of decompensation who will require greater resource utilization.

Acknowledgments

The authors would like to thank the Medicine Department for assistance with drafts of the manuscript.

References

Diverticular colitis is the term used to describe a particular pattern of active chronic inflammation in the sigmoid colon affected by diverticular disease, namely the occurrence of luminal mucosal inflammation, whether or not there is evidence of inflammation within and/or around the diverticula themselves. The pathogenesis remains uncertain but is almost certainly multifactorial. In some cases mucosal prolapse, faecal stasis and relative mucosal ischaemia have been implicated as important pathogenetic factors, whilst other cases are clearly the result of a mass effect caused by subserosal peridiverticulitis and suppuration. Symptoms and endoscopic findings are diverse. Histologically, the disease may vary from modest inflammatory changes with vascular ectasia, through classical mucosal prolapse changes, to florid active chronic inflammation, closely mimicking chronic inflammatory bowel disease, especially ulcerative colitis. Thus, accurate clinical and endoscopic correlation is vital for the attainment of the correct diagnosis. Diverticular colitis may respond well to treatment similar to that used for chronic inflammatory bowel disease, adding to the similarities of this disease, notably localised to the sigmoid colon, and ulcerative colitis. Indeed, in a few cases described in the literature, diverticular colitis may ‘progress’ to otherwise classical ulcerative colitis, suggesting, in some cases at least, a similar pathogenesis.

Diverticulitis is a condition onset by infection or rupture of diverticula, which are bulges forming in the lower part of the large intestine or colon. The risk of developing diverticula is usually higher for people over 40. Diverticula themselves do not cause many problems, but once the condition progresses into diverticulitis, it can be quite severe, leading to pain, nausea, and changes to bowels.

As mentioned, the immune system is suspected to play a role in ulcerative colitis, along with genetics and environmental factors. Certain genes seem to be involved in the development of ulcerative colitis, and having more than four family members with this condition increases your risk of developing it, too. Environmental factors include place of residence, especially because there are higher rates of ulcerative colitis in urban areas, North America, and Western Europe. Air pollution, medications, and certain diets have also been found to be associated with a higher risk of ulcerative colitis.

When symptoms of ulcerative colitis are severe, hospitalization may be necessary. Oftentimes, severe cases lead to dehydration and malnutrition. Acute symptoms could be a sign of a perforated colon or even cancer. Surgery may be required. There are two surgical options. One, called a protocolectomy, involves removal of the entire colon and rectum. The other, called ileonal anastomosis, involves removal of part of the colon. When proctocolectomy is performed, a surgeon makes a small opening in the abdominal wall to bring the tip of the lower small intestine through the skin’s surface. Waste is then drained through the opening into a bag. With the ileonal anastomosis, feces can still pass through the rectum since the rectum is intact, but the movements will be frequent and watery.

Medical treatments for diverticulitis include antibiotics to treat infection, liquid diet to allow bowels to heal, and over-the-counter pain relievers. In complicated cases of diverticulitis, surgery may be required involving primary bowel resection, where the affected part of the intestine is removed, and the rest of it is reconnected. Another option is bowel resection with colostomy if it is impossible to reconnect the colon to the rectum due to inflammation.

Ulcerative colitis is now recognized as a disease involving all age groups. In older patients it may start de novo, or it may exist for a long time in the chronic stage with periodic exacerbations. One would therefore expect it to be associated with diverticular disease of the colon, which is prevalent in the later decades. Collins (3) reported 16 cases of ulcerative colitis engrafted on acute diverticulitis in a series of 1,140 consecutive cases of acute diverticulitis coli. He indicated a grave prognosis with a marked increase in morbidity and mortality. The roentgen recognition of this association therefore merits closer scrutiny.

True diverticula of the colon may be an incidental finding in ulcerative colitis (Figs. 1 and 2). They are lined with mucosa, which may or may not be involved with the ulcerative process. The roentgen appearance may be such as to allow no diagnosis except colonic diverticulosis as an incidental finding in a patient with ulcerative colitis. A radiologically normal colon does not rule out ulcerative colitis (1). Similarly, colonic diverticulosis in an otherwise radiographically normal colon does not eliminate the possibility of associated ulcerative colitis. Sigmoidoscopy, under such circumstances, is the only method of revealing the ulcerative disease in addition to the diverticula. Whether or not the diverticula participate in the inflammatory process is impossible to determine from the roentgen appearance.

Collins has indicated that, when both diseases are present in an inflammatory state, diverticula may become completely necrotic with marked inflammation, to an extent that their lumina may be barely visible. The ulcerative colitis process within the mucosa of the diverticula results in diverticulitis, a distinctly different entity from conventional diverticulitis. The diverticula may perforate; localized abscesses or peritonitis may develop; or other complications inherent in either disease may appear. The association of the two diseases results in greater morbidity and mortality.

The roentgen diagnosis of this entity is based on evidence of diverticula and of ulcerative colitis. Frequently, the manifestations of either the diverticular disease or the ulcerative colitis are dominant, one obscuring the other. Even when both are demonstrated on the film, their association may be sometimes overlooked. The radiologic literature to date has no specific reference to the association of these diseases.

Constant pain or discomfort in your gut can have a significant effect on your quality of life. Never knowing when the symptoms may appear also can affect whether you go out, participate in activities, travel, or even feel comfortable at work. Diverticulitis and diverticulosis, two digestive conditions that can cause abdominal pain, cramping, bloating, constipation, and diarrhea, affect more than 2 million people in the United States. But how can you tell if you have diverticulosis or diverticulitis, and what are the differences?

The colon (large intestine) wall is usually smooth, allowing contents to move unimpeded from the small intestine through the colon to the rectum. Diverticulosis occurs when small sacs—diverticula—begin to bulge from the colon wall. One sac alone is called a diverticulum. These sacs can range from pea-size to much larger. Diverticula can form anywhere in the large intestine, but they’re most commonly found at the end, closest to the rectum in the section called the sigmoid colon.

Diverticula alone don’t often cause any symptoms. If the diverticula become red, inflamed or infected, the condition is diverticulitis (the suffix ‘itis’ means inflammation). Although diverticula can form at any age, diverticulitis is most often diagnosed among people who are 50 years or older. In this age group, it is diagnosed more often among women. However, diverticulitis is more common among men in younger age groups.

Most people with diverticulosis don’t know they have it. The diverticulosis symptoms that may occur, such as cramping, bloating or constipation could easily be mistaken for other common bowel conditions. Oftentimes, you learn you have diverticulosis while undergoing a medical exam for another issue. For example, your doctor may find diverticula during your colonoscopy for colon cancer screening.

Since diverticulosis often doesn’t have bothersome symptoms, you may not need treatment. However, if you are experiencing symptoms, some dietary changes may slow down spasms in the intestines, allowing the contents to move through more easily. Doctors typically recommend high fiber foods or possibly a fiber supplement. Finding the right diet may take some trial-and-error as you find which foods may trigger symptoms and which make you feel better. It will also help prevent diverticulitis.

Bleeding from diverticulosis often stops on its own, but if it is continuous or heavy, your doctor may refer you for a colonoscopy. The gastroenterologist will try to stop the bleeding with heat, clips or laser. In some cases, angiography may be necessary to treat the bleeding. With this procedure, the doctor inserts a catheter into the artery leading to the diverticulum and injects a drug to reduce the blood flow. Rarely, a surgeon may have to remove part of the colon.

The main difference between diverticulosis and diverticulitis is how it affects your health. Diverticulosis may cause some mild symptoms, but diverticulitis can cause serious complications.
If you have been experiencing symptoms that could be related to diverticulosis or diverticulitis, speak with your doctor to see if you need to be tested. Most people manage well with a diagnosis of diverticular disease, but the key is identifying it and following your treatment plan.

Colitis and diverticulitis are two inflammatory diseases of the colon that are difficult to diagnose based on clinical signs alone.Inflammation of the colon is called colitis. Diverticulitis is inflammation of the diverticula of the colon. As can be seen from the definitions, colitis is a condition that occurs in the colon, whereas diverticulitis is a condition that occurs in diverticula. This is the main difference between colitis and diverticulitis.

Colitis versus diverticulitis
Inflammation of the colon is called colitis.	Inflammation of colon diverticula is known as diverticulitis.
Location
It occurs in the colon.	This occurs in the diverticula.

A diverticulum occurs as a result of protrusion of the mucous membrane through the muscular layer of the intestinal wall in its weakest places.Modern ideas about diverticular disease are based on the leading role of the vascular factor in its development: with spasm of the muscle layer, intramural vessels are compressed with impaired microcirculation – ischemia and retardation of venous outflow. All of the above leads to dystrophic changes and expansion of the perivascular spaces, which subsequently become the mouths of diverticula. Thus, diverticula are the final manifestation of the disease of the intestinal wall, dissociation of the circular muscle layer, atrophy and expansion of it in weak places (in the area of perforating vessels).

The most common symptoms of diverticulitis are sudden onset of abdominal pain and abnormal stool.Since diverticula and, accordingly, diverticulitis can occur in any part of the colon, the symptoms of diverticulitis can resemble a variety of diseases: from stomach ulcer and duodenal ulcer, acute appendicitis, intestinal ischemia, intestinal obstruction, colon cancer to renal colic and adnexitis. Inflammatory signs such as fever and leukocytosis help distinguish diverticulitis from spastic pain in irritable bowel syndrome [5].

In addition to clinical and laboratory studies, instrumental studies, usually listed in the following order, play an important role in the diagnosis of diverticulitis: plain radiography of the abdominal cavity, irrigoscopy, computed tomography, ultrasound and endoscopy.However, in recent years, marked by the accumulation of experience in ultrasound examination of hollow organs, this sequence can be revised. In connection with the above, we consider it necessary to present the following clinical observation.

Patient B., born in 1944, turned to the gastroenterologist of the polyclinic with complaints of constant aching pains of moderate intensity in the left lower abdomen, continuing for 2 days after an error in the diet, an increase in body temperature to 38.5 ° C, general weakness, malaise.Anamnesis data: 10 years ago – combined treatment for stage I right breast cancer (RME + LT + HT), stage 2 hypertension, moderate type 2 diabetes mellitus, diabetic polyneuropathy, chronic gastroduodenitis, post-extirpation condition uterus with appendages about fibroids.

On examination, the patient’s condition is relatively satisfactory. The skin and visible mucous membranes are normal in color. The abdomen on palpation is soft, painful along the descending colon, in the left iliac region.The liver is not enlarged, not palpable. Bubble symptoms are negative. Constipation within 2 days. Pasternatsky’s symptom is negative on both sides. There is no dysuria. In an urgent general blood test, moderate leukocytosis (9700).

Ultrasound revealed diffuse changes in the liver and pancreas, signs of chronic acalculous cholecystitis, angiomyolipoma of the left kidney (without dynamics for several years), condition after extirpation of the uterus with appendages. In the left iliac region, corresponding to the zone of maximum palpation tenderness for 9 cm, thickening of the colon walls up to 6-7 mm was noted (Fig. 1). Bowel peristalsis was absent, haustration was poorly expressed, while several painful protrusions of low echogenicity, with a size of 7 to 20 mm, were visualized when pressed with a transducer (Fig.2, a, b) with a thin wall up to 0.9-1.1 mm and the presence of fragments of intestinal contents and gas in some of them (Fig. 3, a, b).

With transvaginal ultrasound (Fig.4), a fragment of the colon with thickened hypoechoic walls and several rounded diverticula up to 1 cm in diameter was also visualized. The contours of one of the diverticula were uneven, it had a stellate shape. Thickening and increased echogenicity of peri-intestinal adipose tissue were noted compared to the contralateral side. When viewed in the mode of ultrasound angiography, the thickened intestinal wall and diverticula were avascular, the surrounding tissue was hypervascular.

With irrigoscopy performed 4 weeks after the patient was discharged from the hospital (Fig.5), the large intestine was examined under double contrast conditions. Barium suspension and air filled all sections and the usually located vermiform appendix. The barium suspension did not penetrate into the small intestine. The sigmoid colon was lengthened. The location of the loops is usual, the contours are even, clear, the walls are elastic. Gaustation is well expressed, uneven in the left half. In the left half, mainly in the sigmoid colon, multiple diverticula of different sizes were found, in the area of the hepatic flexure – single small diverticula.Deformations of the intestine, narrowing of the lumen, intraluminal formations were not found. Bowel emptying is incomplete, uneven. Conclusion: colon diverticulosis with a predominant lesion of the left sections.

Irrigoscopy can lead to an exacerbation of the disease and be more harmful than beneficial, since the ingress of barium into the abdominal cavity in case of perforation of the diverticulum can cause chemical peritonitis.However, special studies carried out have confirmed that irrigoscopy may not harm the patient and indeed be of great benefit when using water-soluble contrast agents. For mild to moderate diverticulitis, when the diagnosis is not completely clear, fluoroscopy with water-soluble contrast agent is safe and of great help; if the disease is severe, it is advisable to postpone the examination for 6-8 weeks. Thus, the method has a number of limitations associated with the acute period of the disease.

Colonoscopy, in addition to determining the presence of diverticula, makes it possible to clarify the extent of inflammatory changes in the intestinal lumen, the location of the diverticula and the state of their mucous membrane: hyperemia and edema of the mucous membrane in the area of diverticula, the presence of pus in the intestine. However, acute diverticulitis is a relative contraindication to endoscopic examination, since the very manipulation of the endoscope and the bloating of the intestine with air can lead to perforation of the diverticula and the development of abscess or peritonitis.Colonoscopy should be performed only when the diagnosis is unclear and differential diagnosis is made between obstructing tumor, bowel ischemia, inflammatory bowel disease, and infectious colitis. Thus, the method has practically the same limitations as the X-ray contrast study.

Computed tomography is performed in all cases of diverticulitis with palpable tumor formation in the abdomen or clinically severe intoxication, in the absence of the effect of conservative therapy; it is the method of choice for diagnosing complicated diverticulitis.computed tomography allows you to carefully examine not only the intestinal wall, but also organs and tissues outside it, helps to detect diseases not associated with diverticulitis, such as ischemic colitis, mesenteric thrombosis, tubo-ovarian abscess and pancreatitis. Diagnostic criteria for acute diverticulitis on computed tomography are local thickening of the colon wall (more than 5 mm), inflammation of the peri-intestinal fatty tissue, or the presence of a peri-intestinal abscess. Although the method does not have limitations associated with the acute period of the disease, it still cannot compete with ultrasound in terms of accessibility for the population.

Ultrasound scanning is the safest non-invasive method for diagnosing acute diverticulitis, which can be used at any stage of the disease. The lack of information content of this study is a consequence of the content of a large amount of gases in the intestine. False negative results are observed in 20-25% of cases in the absence of false positive conclusions. The result of the study largely depends on the qualifications of the doctor: when carried out by an experienced researcher, the sensitivity is 74.2%.The results of ultrasound examination are close to the results of computed tomography. At the same time, in patients with diverticulitis, a thickening of the intestinal wall with the presence of saccular or triangular formations extending beyond the contour of the altered segment of the intestine, infiltration of peri-intestinal fatty tissue, intramural fistulas, stenosis of the colon with characteristic changes in the diameter of the lumen can be detected: narrowing at different lengths with a thickened due to the muscular layer by the wall and suprastenotic expansion.Intestinal strictures that have developed as a result of a malignant tumor are characterized by sharp boundaries on both sides, while strictures that have developed as a result of diverticulitis are distinguished by smoother contours and greater length [4, 6, 7].

In the above observation, ultrasound showed multiple protrusions of the thinned intestinal wall. In the areas of the thickened wall between the diverticula and in the diverticula themselves, the vascular pattern was depleted or not visualized, which confirms the role of the vascular factor in the development of the disease: compression of intramural vessels with impaired microcirculation, the presence of ischemia and slowing of venous outflow.Some diverticula were filled with homogeneous avascular contents of moderate echogenicity, without signs of intraluminal movement, so that the contents merged with the image of the wall. In other diverticula, gas bubbles, acting as a natural contrast, made it possible to examine in detail the intestinal wall thinned to 0.9-1.1 mm, devoid of the hypoechoic muscle layer. The shape of these diverticula approached spherical, the orifice was smaller than the diameter of the diverticulum. However, there were also protrusions in the form of cones, with orifices exceeding the size of the diverticulum itself, in which the continuation of the hypoechoic muscle layer of the wall was traced.

Diverticula are small sacs that protrude outward from the wall of the colon or colon. If they develop, the victim is said to be suffering from diverticulosis. These bags are harmless as long as there is no debris or inflammation on them. If these sacs become inflamed or infected, it causes an acute condition called diverticulitis, which requires immediate treatment. recurrent or chronic constipation, etc.This causes small marble-sized bags to protrude through the colon wall. Diverticulitis occurs when these benign tears diverticulum, resulting in inflammation or infection or both.

The main cause of diverticular disease is a diet low in fiber. There are many other factors thought to contribute to its cause. Aging, obesity, smoking, and lack of exercise increase the likelihood of developing diverticulitis.A diet high in animal fat and low in fiber also increases the risk of diverticulitis. The reason they are likely to lead to diverticulosis is because they lead to constipation or poor excretion of faeces from the colon, resulting in increased pressure in the colon canal.

Most people with diverticulosis usually have no symptoms. However, you can sometimes complain of mild cramps, bloating, or constipation. Diverticulosis is usually diagnosed by chance when tests are ordered for some other condition. Abdominal pain thought to be caused by diverticular disease is usually due to concomitant painful conditions such as irritable bowel syndrome (IBS). It is usually more common in the geriatric population.

Most people with colon diverticula are unaware of them due to the absence of acute symptoms. The condition for the presence of colon diverticula is called diverticulosis. They are most often discovered by accident during an imaging procedure. Sometimes, these diverticula can become inflamed or infected, leading to a condition called diverticulitis. Complications are rare. But, if they do, they are usually of a serious nature.A low fiber diet is thought to cause diverticular disease. Therefore, increasing the fiber content in the diet can help prevent it.

Cat’s claw is used in the complex therapy of the following diseases and conditions: allergic diseases and reactions, influenza, acute respiratory infections, inflammatory ear diseases, herpes (including genital), parasitic infections, yeast infections; various types of malignant neoplasms, arthritis, arthrosis, rheumatism, bursitis, muscle pain associated with overwork or hard physical work; Crohn’s disease, ulcerative lesions of the gastrointestinal tract (including after chemotherapy), gastritis, diverticulitis, colitis, constipation, diarrhea, flatulence, hemorrhoids; lupus, diabetes mellitus, premenstrual syndrome, prostatitis, hypoglycemia 1.

Modern radiology diagnostics of diseases of the abdominal organs is completely different from the radiology of the digestive canal of the 40-70s of the twentieth century. For decades, for the study of this anatomical zone, only general images, contrasting with barium of the stomach and intestines, and cholecystography were used.The possibilities for assessing the liver, pancreas and bile ducts, extraorgan tumors were limited and were based mainly on indirect signs. With the development of endoscopy, the frequency of use of X-ray methods for examinations of the esophagus, stomach and colon began to decrease. On the other hand, fluoroscopy and radiography of the digestive canal organs remain the most important methods for a comprehensive study of these organs. Methods such as oral or intravenous cholecystography and diagnostic retroperitoneum have largely fallen out of use.

The inevitable technological advancement of technology, changes in the organization of medicine and the rapid accumulation of scientific data have transformed abdominal radiology beyond recognition. First of all, this concerns the study of parenchymal organs of the abdominal cavity, where the leading role is currently occupied by ultrasound (ultrasound), computed tomography (CT) and less often – magnetic resonance imaging ( MRI).

Ultrasound has become the main standard method for examining all parenchymal organs of the abdominal cavity.Phased sensors and dummy microprocessor systems have provided an opportunity to significantly improve image quality and reduce the severity of artifacts. Color Doppler examination is a standard method for studying the vessels of the abdominal organs and examining the vascularization of the identified pathological formations and structures. Three-dimensional ultrasound techniques have appeared. The use of endoscopic sensors for intracavitary studies significantly expands the capabilities of this method in difficult cases.Contrast agents for ultrasound, intended for the study of perfusion and detection of focal liver lesions, are being investigated.

After the appearance of helical CT (SCT) in 1989, the method became voluminous.With SCT, a permanently switched X-ray tube rotates around a continuously moving table. Accordingly, the spatial and temporal resolution of the method has significantly increased, the risk of missing small pathological foci has decreased. The method has become standardized. The next step (1999) was the emergence of multislice CT (MSCT). MSCT systems of the first generation could simultaneously perform 4 slices with a thickness of 0.5 mm per revolution of the tube (its duration was reduced to 0.5 s). At present, the main MSCT fleet consists of devices with 16-64 rows of detectors, in which the tube turnover time is only 320-350 ms, and the slice thickness is 0.5 s.In 2008, devices with 256 and 320 rows of detectors appeared. Currently, all new CT systems are multispiral. Thanks to technological advances, CT has begun to be applied in areas previously inaccessible to it. CT angiography was introduced and the method was used to visualize hollow organs. The techniques of CT colonography and gastrography were created. It has been proven that the diagnostic efficacy of CT colonoscopy is comparable to that of traditional fiber-optic colonoscopy. Taking into account the speed and ease of CT colonography of patients, the expediency of using this method for screening colon cancer is discussed.

However, CT is most commonly used for the diagnosis and differential diagnosis of focal lesions of the liver and pancreas. CT with a bolus of 100-140 ml of contrast medium is standard. A multiphase study in different contrasting phases (of which the most important are arterial and portal-venous) makes it possible to identify and characterize focal lesions of the liver and pancreas, plan treatment and evaluate its results.With the help of MSCT, it is possible to visualize with high accuracy the arteries and veins of the abdominal organs, as well as the bile ducts.

MRI is less commonly used in abdominal studies than ultrasound and MSCT, primarily for economic reasons.However, when properly selected, it provides important diagnostic information. One of the most important areas of application for MRI is in liver studies. Due to the multiparametric nature of MR images, the possibility of obtaining a series of sections with varying parameters, emphasizing the contrast in terms of magnetic relaxation parameters (T1, T2), suppression of the signal from fat, good visualization of arteries and veins without contrast, MRI has become the most important method for detecting focal liver lesions.The method of MR cholangiography allows you to see the extra- and intrahepatic bile ducts non-invasively, without resorting to artificial contrast. This technique is based on amplifying the signal from immobile fluid (bile) and suppressing the signal from dense tissues and blood. When inflating the colon loops cleaned of the intestinal contents with air or special fluids, it is possible to perform MR-enterography or colonography. The use of contrast agents based on gadolinium (Magnevist, Gadovist, Omniscan, Optimark, etc.)) further expands the capabilities of the method. Relatively recently, a new class of contrast agents for MRI has appeared – hepatotropic (organ-specific) agents, such as Primovist, Teslaskan and a number of others. These drugs have a dual mechanism of action, making it possible to characterize both vascularization and the cellular composition of the studied intrahepatic structures.

The scope of use of radionuclide techniques in abdominal radiology has been significantly reduced. They have lost their importance as methods for studying the anatomy of internal organs. The main role of radionuclide methods (primarily positron emission tomography / PET /) in abdominal radiology is tumor staging, detection of metastatic lesions (primarily liver). Less commonly, radionuclide methods are used to detect hidden (occult) bleeding from the gastrointestinal tract and to study liver function.

Test organ	Method	Objective
Abdominal organs	Plain view of the abdominal cavity	Examination of patients with “acute abdomen”, diagnosis of intestinal obstruction, perforation of hollow organs, detection of X-ray-positive calculi
Esophagus	Radiography / fluoroscopy of the esophagus	Identification of hiatal hernias, diverticula, strictures, obturations, varicose veins, tumors, foreign bodies
Stomach and duodenum	Radiography / fluoroscopy, conventional technique Radiography / fluoroscopy, double contrast	Diagnostics of ulcers, tumors, strictures, obturations, malabsorption syndrome, control of operation results
Duodenum	Relaxation duodenography	Diagnosis of tumors of the head of the pancreas, Vater’s nipple, diseases of the duodenum
Small intestine	Barium passage (oral contrast enhancement) Enteroclysm (transducer contrast medium)	Diagnosis of intestinal patency, identification of the causes of strictures, obstruction, tumors, inflammatory diseases
Large intestine	Irrigoscopy (retrograde contrast) Double contrast CT colonoscopy MR colonoscopy Endoscopic ultrasound	Diagnosis of tumors, inflammatory diseases, diverticula, identification of the causes of intestinal obstruction
Gall bladder bladder and ducts	Retrograde cholangiopancreatography Direct (puncture) cholangiography Ultrasound, CT, MRI MR cholangiography	Assessment of the state of extrahepatic and intrahepatic bile ducts (calculi, strictures, tumors), diagnostics of tumors of the pancreatic head, Vater’s papilla, inflammatory and tumor diseases
Liver	Ultrasound CT MRI PET	Diagnostics and differential diagnosis of focal liver lesions, diffuse diseases, injuries
Pancreas	Ultrasound Endoscopic Ultrasound CT MRI	Inflammatory diseases, calculi, tumors, trauma, developmental anomalies

For the study of the esophagus, X-ray examination with barium is traditionally used (Fig.1). The process of passing sips of barium suspension (or a special barium preparation) is recorded using fluoroscopy in real time. A frequent indication for X-ray examination of the esophagus is the diagnosis of gastroesophageal reflux. It is manifested by a reverse throw of barium suspension from the stomach into the esophagus when examined in a horizontal position or in the Trendelenburg position. In the case of obstruction of the esophagus by a foreign body, X-ray examination allows you to immediately establish its level and severity.With this method, areas of expansion and narrowing of the esophagus are clearly visible in benign strictures (cicatricial, achalasia). Achalasia is characterized by the expansion of the proximal part of the esophagus and the narrowing of its distal part in the form of a “beak”. With tumors of the esophagus (benign and malignant), a defect in the filling of the esophagus is visible. A characteristic sign of malignant tumors (cancer) is mucosal ulceration and changes in its X-ray pattern, rigidity of the esophagus walls, uneven tumor contours (Fig.2). Various types of esophageal pathology (hiatus hernia, tumor, enlargement) are well identified using CT or MRI. CT allows you to well detect the spread of tumors outside the esophagus. Endoscopic ultrasound is sometimes used to assess the walls of the esophagus in detail.

As already mentioned, due to the higher information content, endoscopic methods have somewhat pushed X-ray methods in the diagnosis of diseases of the stomach and duodenum. At the same time, it is essential that the fluoroscopy of the stomach gives a complete picture of the anatomy and function of the organs under study (Fig. 3). This is especially important when detecting diffusely growing tumors, assessing the degree of cicatricial lesions of the walls, violations of the evacuation of contents.For this reason, fluoroscopy and radiography of the stomach and duodenum are included in most of the standard examination schemes for patients with diseases of these organs.

The classic indication for X-ray examination of the stomach is the diagnosis of gastric ulcers and 12 duodenal ulcers.Stomach ulcers are most often localized on the lesser curvature, and duodenal ulcers – in the area of its bulb. However, any localization of ulcers is possible. The most reliable radiological symptoms of ulcers are “niche” and “crater” symptoms, local changes in the mucosal pattern, edema and wall stiffness at the site of ulcer localization (Fig. 4, Fig. 5). Radiography well reveals the consequences of peptic ulcer – areas of cicatricial deformity of the stomach and duodenum 12. Sometimes ulcers can be complicated by penetration into the surrounding organs (pancreas, hepato-duodenal ligament, omentum, liver and biliary tract), as well as into the abdominal cavity.In this case, plain radiography or an image on the right side (laterography) reveals free air in the abdominal cavity, indicating perforation of the hollow organ. It should be noted that if you suspect perforation of one of the organs of the alimentary canal, barium intake is contraindicated. In this case, water-soluble iodine-containing contrast agents are used to contrast the organs of the digestive canal. Diagnosis of perforations and associated complications is also possible with the help of ultrasound and CT.

Radiography and fluoroscopy remain important methods for the diagnosis of benign and malignant gastric tumors. Their differential diagnosis is based on the analysis of tumor contours, the nature of changes in the folds of the stomach and local rigidity of its walls (Fig. 6). In all cases, if a tumor is detected during an X-ray examination of the stomach and duodenum, endoscopy with a biopsy is prescribed. Currently, more and more often stomach tumors are first detected during CT scan of the abdominal organs (Fig.7) (most often as an accidental find), after which patients are referred to a specialized study. Ultrasound and MSCT are widely used to assess local invasion of malignant tumors (invasion of the stomach wall and surrounding structures) and to identify local and distant metastases.

As already mentioned, for studies of the small intestine, an assessment of the passage through it of barium suspension or a water-soluble contrast agent, as well as probe enterography, is used.Recently, a lot of attention has been attracted by such techniques as CT or MR-enterography, in which it is possible to construct three-dimensional images of an organ and to construct images of the intestinal lumen in an endoscopic mode. Tumors of the small intestine, in comparison with the higher and lower parts of the alimentary canal, are rare. With a radiation examination of this organ, a frequent indication for research is the diagnosis of small bowel obstruction and its cause, identification of local inflammatory lesions (most often the terminal section in Crohn’s disease), examination of patients with acute abdomen syndrome.If acute small bowel obstruction is suspected, an overview image of the abdominal cavity is performed (Fig. 9), CT or ultrasound is even more informative in identifying the obstruction and diagnosing its cause. The use of MR or CT enterography in Crohn’s disease provides information that is often not available for endoscopic examination. So, these methods make it possible to see not only the thickened, ulcerated areas of the ileal wall, but also the infiltration of the surrounding tissue, local expansion of the mesenteric vessels, and an increase in regional lymph nodes.

Irrigoscopy is still one of the most important methods for examining all parts of the colon. It supplements the colonoscopy data and allows you to obtain more complete information about the state of the organ (Fig. 10). One of the most common indications for irrigoscopy is the diagnosis of colon cancer, polyps and diverticula. With irrigoscopy, colon cancer is seen as a filling defect with a clear boundary between the unchanged mucous membrane and the tumor; signs of stiffness of the intestinal wall are revealed.Often, a site of tumor lesion causes a circular narrowing of the intestinal lumen (a symptom of “apple core”). X-ray manifestations of colon cancer depend on the histological form of the tumor, location and extent of its spread. MSCT and, in particular, the CT colonography technique can serve as an alternative to irrigoscopy in the screening and diagnosis of colon cancer. CT allows you to better see changes in the intestinal wall and stage the disease (Fig. 12). Transrectal ultrasound has also been used to diagnose early stages of rectal and sigmoid colon cancer.

An overview of the abdominal cavity, ultrasound and CT can determine the cause of the acute abdomen and intestinal obstruction. One of the most common causes of acute abdomen syndrome when pain is localized in the right lower quadrant is appendicitis.CT and ultrasound (Fig. 14) provide visualization of the inflamed and enlarged appendix, timely diagnosis of complications (development of infiltrates, abscess formation, perforation). These two methods are indispensable for the diagnosis of other causes of “acute abdomen” (obstruction of the ureter with a stone, acute pancreatitis, acute cholecystitis, pancreatitis, perforation of the hollow organ and other pathology).

The same trend is observed in the diagnosis of intestinal obstruction. The most common mechanical intestinal obstruction caused by tumors, adhesions, intussusceptions, hernias, gallstones and fecal stones.With the development of intestinal obstruction, intestinal pneumatosis develops, as it progresses into the intestinal loops with fluid. Liquid levels with accumulations of gas above them in dilated bowel loops (“Kloyber’s cups”) are a classic symptom of intestinal obstruction. In case of small bowel obstruction, the vertical dimensions of the “Kloyber bowls” prevail over the horizontal ones; characteristic semi-lunar folds of the intestinal mucosa are visible; in colonic the horizontal dimensions of the fluid levels prevail over the vertical ones, the gaustra are visible.CT and ultrasound better identify intestinal obstruction in the early stages of its development than an overview image, in addition, usually with their help, it is possible to establish its cause (Fig. 15).

Diagnosis of fatty liver infiltration using radiation methods is quite reliable. Typically, areas of fatty infiltration alternate with areas of normal liver parenchyma. Fatty infiltration does not lead to a violation of the architectonics of the liver vessels or the mass effect. The picture of fatty infiltration can undergo rapid dynamics, which is of important differential diagnostic and prognostic significance. With ultrasound, fatty degeneration of the liver is clearly visible. It looks like diffuse liver changes with reduced echogenicity, interspersed with areas of unchanged tissue.With CT, there is a significant decrease in the density of the organ parenchyma (up to 20-30 Hounsfield units) (Fig. 16). Due to a decrease in its density, the affected segments become clearly visible against the background of unchanged areas of the liver tissue and liver vessels. Normally, the density of the liver is slightly higher than the density of the spleen. Therefore, with fatty infiltration, a decrease in the density of liver tissue is visible even without the help of densitometry. MRI is rarely used to confirm the diagnosis. Ultrasound and CT are sufficient for this purpose.However, if MRI is performed in these patients, then special research programs are used (pulse sequences with suppression of the signal from adipose tissue).

In the diagnosis of liver cirrhosis, the information content of methods of radiation diagnostics is significantly higher. Allocate macro-nodal, micro-nodal and mixed forms of liver cirrhosis. With micronodal cirrhosis, the liver is reduced in size and significantly compacted, the regenerative activity is insignificantly expressed. With macronodular cirrhosis, multiple regeneration nodes are revealed, some of them are multilobular, with septa.The main criteria for the diagnosis of cirrhosis are a decrease in the size of the liver (at the initial stages of the disease, the liver can be enlarged in size), the identification of multiple nodes of regeneration, the presence of signs of portal hypertension, splenomegaly, and ascites. The most informative for diagnosis are CT, ultrasound and MRI (Fig. 17). Assessment of the nature of blood flow in the portal vein and hepatic veins using Doppler ultrasound can help in assessing the degree of impairment of venous blood flow in the organ.Sometimes there is a need for differential diagnosis of foci of hepatocellular carcinoma and regeneration nodes in cirrhosis. In cases difficult to diagnose, they resort to puncture biopsy. It can be performed under the supervision of ultrasound or CT, which increases the accuracy of material sampling and reduces the risk of complications.

Hepatocerebral dystrophy (Konovalov-Wilson disease) is caused by disorders of copper metabolism, which is deposited in the liver, kidneys, and brain. When examining the liver, hepatitis or cirrhosis of varying severity is detected. Most important, however, is the characteristic increase in liver parenchyma density on CT (or an increase in signal intensity on MRI). This is due to the increased content of copper ions in the organ. With hemochromatosis (primary or secondary), there is an increased accumulation of iron in the cells of the reticuloendothelial system.Accordingly, the nature of the image of the liver on computed tomograms changes (increased density) and the change in the signal during MRI (low intensity of the signal from the liver parenchyma both on T1 and on T2-weighted images – Fig. 18). The latter is explained by the peculiarities of the magnetic properties of iron oxides in the cells of the reticuloendothelial system.

Simple liver cysts are common. On ultrasound and tomographic images, they have different sizes, thin walls, homogeneous contents with characteristics characteristic of a liquid, close in density to water. There are no vessels inside the cysts. The content of simple cysts is not enhanced by the administration of a contrast agent. Liver cysts occur in 20-40% of patients with polycystic kidney disease.

Infectious abscesses can occur after liver trauma, surgery, cholangitis, sepsis, phlebitis of the portal vein. With Doppler ultrasound, increased vascularization of the capsule is visible, the absence of a signal from the blood flow inside the abscess cavity. On ultrasound, a liver abscess appears as a round structure with a dense, uneven capsule, thick walls and an uneven inner surface.A dense liquid content is lodged inside, the presence of gas is possible. Amoebic abscesses are characterized by a thick capsule with multiple internal partitions, the absence of gas accumulations in the abscess, and multiple lesions are not uncommon. A similar picture is obtained with the use of CT and MRI. In doubtful cases, they resort to intravenous contrasting. Increasing the contrast of the abscess capsule and identifying gas bubbles in its cavity allows a correct diagnosis to be made (Fig. 20).

The liver, spleen and lungs are the main organs of dissemination of the larvae of echinococcus and alveococcus. Lesions of other organs (kidney, grave, heart, etc.) are much less common. Initially, after infection, the cysts are small (2-3 mm), and their identification can be extremely difficult. As they grow, the diagnosis becomes easier. For all methods, the most characteristic signs of echinococcosis are the presence of cysts of various sizes in the liver with clear, thin and even walls.The diagnosis of echinococcosis is facilitated when the formation of daughter cysts is found inside or outside (Fig. 21). With echinococcosis, in 30% of cases, the walls of the cyst are calcified. In the case of the death of the parasite, partial or complete detachment of the inner membrane is often observed, which becomes clearly visible inside the cystic cavity. In alveococcosis, cysts are multiple, their contours are indistinct due to infiltrative growth with inflammatory and necrotic reactions along the periphery of the cysts. The density inside the cyst is higher than with echinococcosis.Therefore, the formation can resemble a growing tumor.

Hemangioma is the most common benign liver tumor. It occurs in 1-5% of the adult population. In the overwhelming majority of cases, hemangiomas are discovered by chance with ultrasound or tomography of the liver.Very rarely, giant (> 10 cm) hemangiomas can be accompanied by clinical symptoms due to compression of the surrounding structures, thrombosis, hemorrhages. On ultrasound, the hemangioma looks like a round formation with multiple signals inside the tumor from small vessels. On CT images, hemangiomas typically appear as low-density, rounded formations with clear contours. When a formation similar to a hemangioma is detected, it is imperative to carry out intravenous contrasting. A characteristic of hemangiomas is the centropetal (from the periphery to the center) sequence of filling the hemangioma with a contrast agent (Fig.22).

On MRI, due to the long relaxation time on T2-weighted images, a very bright image of the tumor against the background of the dark liver parenchyma is characteristic. In dynamic contrast MRI study with gadolinium, the pattern of filling the tumor with contrast is the same as in CT. Large hemangiomas may have an atypical appearance – extended central zones, poorly, or not accumulating contrast agent (scars, areas of hyalinosis). In rare cases, liver scintigraphy with labeled erythrocytes or angiography is used to diagnose hemangiomas.

Focal nodular hyperplasia is a rare benign liver tumor that usually occurs in young women (up to 75% of cases). It consists of hepatocytes, Kupffer’s cells and bile ducts. In its central part, there is usually a scar, from which septa (septa) diverge. It can be multiple. On the images, this tumor is characterized by the absence of a capsule, structural homogeneity and hypervascularity. Without contrast enhancement, the tumor usually has the same signal characteristics as the liver parenchyma.A large tumor can disrupt the course of the liver vessels. This tumor is hypervascular, so it is well detected by dynamic CT or MRI with contrast enhancement in the arterial phase (Fig. 23). Usually, a hypointense central scar is clearly visible, which accumulates a contrast agent in the stunted phase, while the tumor parenchyma becomes almost indistinguishable from a normal liver.

Adenoma is a rare benign liver tumor consisting of hepatocytes. It is supplied with blood by one or more additional branches of the renal artery.When performing ultrasound, CT or MRI, it looks like a space-occupying mass, often surrounded by a thin pseudocapsule (zone of fibrosis). In the tumor tissue, areas of hemorrhage can be detected, the central scar is absent. During CT and MRI with contrast enhancement, the adenoma is contrasted mainly in the arterial phase. In this case, an inhomogeneous increase in density is noted. Sometimes an adenoma is difficult to differentiate from hepatocellular carcinoma.

Hepatocellular carcinoma (hepatoma) is the most common primary liver tumor. The risk of developing hepatoma is increased in patients with liver cirrhosis, hepatitis B and C, hemochromatosis. Allocate nodular (solitary), multinodular and diffuse forms of the disease. The invasion of the tumor into the portal and hepatic veins is characteristic (up to 30% of cases). Hepatoma can metastasize to other organs (lungs, bones, lymph nodes).

Radiological imaging of hepatoma is quite diverse. The tumor is characterized by inhomogeneity of the internal structure, intratumoral septa, a central scar, necrotic or cystic areas, a capsule, and the presence of daughter nodes can be detected. The tumor can penetrate the vessels, have calcium inclusions and be accompanied by ascites. Hepatomas are usually characterized by increased vascularization and the presence of arteriovenous shunts. For this reason, when performing ultrasound Doppler, angiography or CT and MRI with contrast, they are best seen in the arterial phase (Fig.24).

Cholangiocellular carcinoma (cholangiocarcinoma) is a malignant tumor growing from the intrahepatic bile ducts. With ultrasound or CT, it can look like a hypodense (hypointense on MRI) focus or multifocal formation with infiltrative growth along the bile ducts (Fig.25). The most striking manifestation of the disease is a pronounced expansion of the intrahepatic bile ducts above the site of their obstruction by the tumor and contrasting of the tissue of the formation itself. CT, MRI and especially MR cholangiography facilitate the diagnosis of tumor lesions of the bile ducts. Cholangiocarcinoma, which affects the fusion area of the intrahepatic bile ducts and causes their obstruction, is called Klatskin’s tumor. The disease should be differentiated from cases of benign congenital cystic enlargement of the bile ducts (Caroli’s disease).

Among all focal liver lesions, great importance is attached to the detection of metastases of malignant tumors in the liver. The detection of even a single small-sized metastasis to the liver changes the stage of the process and, accordingly, the choice of treatment tactics and the prognosis of the disease. All methods of modern radiation diagnostics make it possible to visualize liver metastases. Their sensitivity and specificity range from 75-90% and depend on the characteristics of the method itself, the research technique, histological structure, vascularization and the size of the lesions.Most often, ultrasound is prescribed as the initial research method. In difficult situations, the diagnostic algorithm is expanded. CT with multiphase contrast and / or MRI (also with contrast) is performed.

On ultrasound and tomography, liver metastases are visible as multiple soft tissue foci (coin symptom) (Fig. 26). Depending on the histology of the primary focus, they can be hypervascular or hypovascular (most often). The type of metastatic foci on tomograms and the change in their density (intensity in MRI) during contrasting largely depend on vacularization. Sometimes there are metastases with calcifications or with a pronounced cystic component. In doubtful cases, PET or PET / CT with 18-FDG can help diagnose metastatic lesions.

Radiation techniques are important for the diagnosis of portal hypertension. Portal hypertension syndrome occurs in a number of diseases: thrombosis and compression of the portal vein and its branches, cirrhosis of the liver, cholangitis, congestive heart failure and other diseases. Therefore, when examining the organs of the abdominal cavity, it is imperative to study and describe the state of the vessels of the liver and spleen. Portal hypertension is diagnosed based on the expansion of the portal vein, detection of varicose collateral veins, splenomegaly, ascites.In the diagnosis of portal vein thrombosis or Budd-Chiari syndrome (thrombosis of the hepatic veins), CT or MRI performed in angiographic mode play an important role. Doppler ultrasound can be used to determine the speed and direction of blood flow in the portal and splenic veins.

Diseases of the spleen are much less common than diseases of the liver. Diagnostics is carried out using ultrasound and CT, less often by MRI. In the spleen, benign tumors can occur: hamartomas and hemangiomas.Of the malignant tumors, metastases and lesions of the spleen with lymphoproliferative diseases (lymphogranulomatosis, lymphomas) are most often diagnosed. Primary malignant tumors of the spleen are very rare. The principles of diagnosing lesions of the spleen are the same as those of the liver.

Injury to the spleen leads to bruising and rupture of the organ. Accurate information about the condition of the spleen influences the choice of treatment tactics. In this case, diagnostics, as a rule, are carried out urgently. Therefore, ultrasound and CT studies come to the fore.With both ultrasound and CT, you can quickly get comprehensive information. Spleen infarctions of embologous origin in the acute stage are well detected by CT or MRI with contrast enhancement. In the chronic stage, at the sites of CT infarctions, calcifications can be detected.

Acute pancreatitis in the initial stage of its development is manifested by an enlargement of the organ, a diffuse change in the structure of the gland due to its edema.As the disease progresses, peripancreatic fluid accumulations appear, infiltration of the surrounding fatty tissue. It is important to identify necrotic foci in the gland in severe disease. To detect foci of pancreatic necrosis, CT scan with contrast enhancement is required (Fig. 27). In the long-term period, using methods of radiation diagnostics, pseudocysts, calcifications, aneurysms of arteries (most often – branches of the splenic artery) can be detected. Pancreatitis of the head of the pancreas, leading to obstruction of the common bile duct, sometimes has to be differentiated with a tumor.For this purpose, they resort to performing CT or MRI with contrast.

Pancreatic cancer is the most common malignant tumor of the organ. More than half of cases occur in the head of the pancreas. In this regard, jaundice is the first sign of the disease. When diagnosing, it is necessary to differentiate between a tumor, an edematous form of pancreatitis and an uncalcified bile duct calculus. Tumors of the body and tail of the gland do not appear for a long time and therefore are often diagnosed when they reach a large size (4-5 cm).

Diagnosis of a pancreatic tumor by ultrasound, CT or MRI is predominantly based on the detection of local thickening of the gland and focal changes in signal characteristics at the site of the lesion.When clarifying the cause of jaundice and identifying changes in the head of the gland, endoscopic ultrasound and retrograde cholangiopancreatography are of great help. Dynamic contrast CT with thin slices is often performed to clarify the diagnosis. The tumor is usually detected in the form of a hypodense formation against the background of a better contrasting parenchyma of the gland (Fig. 29). MRI using bolus enhancement with gadolinium increases the sensitivity and specificity of the method in detecting lesions.

Cystic tumors of the pancreas (cystadenocarcinoma) are very difficult to diagnose. It is a malignant cystic tumor containing mucin. The tumor is usually localized in the body or tail of the pancreas. With ultrasound, CT or MRI, the tumor looks like a hypovascular structure, its septa and nodes accumulate contrast agent.A benign tumor – a cystadenoma or a multi-chamber pseudocyst – may look similar.

Endocrine tumors (insulinomas, gastrinomas, vipomas, somatostinomas, glucagenomas and non-functioning tumors) are relatively rare in the pancreas. In most cases, these tumors are hypervascular, so they are clearly visible in the arterial phase of contrast enhancement by CT or MRI (Fig. 30). Selective angiography can also detect abnormal tumor vessels.Signs of hormonal activity of the tumor (hypoglycemia in the case of insulinoma, Zollinger-Ellison syndrome in gastrinomas, etc.) are of great importance for the diagnosis. Liver metastases of APUD tumors are also usually hypervascular.

Ultrasound is the leading method for diagnosing diseases of the gallbladder and biliary tract.Using this method, one can see calculi in the gallbladder cavity and the symptom of “acoustic shadow” behind the calculus (Fig. 31). Concrements in the gallbladder and ducts are clearly visible on CT (Fig. 32), as well as on MR cholangiography (as filling defects against the background of a bright signal from bile). On modern multispiral computed tomographs, it is possible to visualize even “X-ray negative” (cholesterol) stones in the bladder, since they usually differ in density from bile.

For the diagnosis of acute and chronic cholecystitis, ultrasound is preferred.With its help, it is possible to reveal the thickening and infiltration of the walls of the bladder (Fig. 33), the expansion of its cavity, the heterogeneity of bile. With complicated cholecystitis (abscess formation or gangrenous changes in the bladder), accumulations of gas and pus can be detected. The accumulation of exudate in the bed of the bladder is often detected.

Ultrasound is also preferred for suspected cholangitis. With the help of the method, the expansion of the intrahepatic bile ducts, periproduct infiltration of the liver parenchyma, and changes in the density of bile inside the ducts are visualized.Chronic cholangitis is characterized by the identification of alternating areas of narrowing (strictures) and widening of the bile ducts, fibrotic and inflammatory changes along their periphery, which can be diagnosed using RCPG, MR-cholangiography or ultrasound. Stones in the intrahepatic bile ducts can be detected. In complicated cholangitis, ultrasound, CT and MRI are used to diagnose complications of the disease such as intrahepatic abscesses.

Lymph ducts and several groups of lymph nodes are located in the retroperitoneal space.Revealing their defeat in malignant diseases is of great diagnostic value. Even with the conventionally normal sizes of the nodes, their quantitative increase should be perceived with caution. The most common cause of enlargement of the retroperitoneal lymph nodes is metastases of malignant tumors of the abdominal cavity or pelvis. In lymphomas (lymphogranulomatosis, non-Hodgkin’s lymphomas), the affected lymph nodes differ from those affected by the metastatic process. They merge into polycyclic masses, which can cause displacement of internal organs, obstruction of the ureters, blood vessels.Mesenteric, retroperitoneal, or pelvic lymphadenopathy may be a manifestation of AIDS.

Difference between diverticulitis and colitis: Diverticulitis vs. Ulcerative Colitis (UC): Differences & Symptoms

Difference Between Colitis and Diverticulitis

CONTENTS

What is Colitis?

Main Causes

Crohn’s Disease

Clinical Picture

Diarrhea

Fibrostenotic Disease

Fistulizing Disease

Local complications of Crohn’s disease

Morphology

Diagnosis

Management

Ulcerative Colitis

Clinical Features

Investigations

Complications

Local complications

General Complications

Management

Medical Management

Surgical Management

What is Diverticulitis?

Clinical Features

Acute Diverticulitis

Chronic Diverticular Disease

Investigations

Treatment

Acute Diverticulitis:

Chronic Diverticular Disease

What are the Similarities Between Colitis and Diverticulitis?

What is the Difference Between Colitis and Diverticulitis?

Colitis vs Diverticulitis

Summary – Colitis vs Diverticulitis

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Diverticulosis and Diverticulitis: What’s the Difference?

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What Causes Diverticulitis and Diverticulosis?

What Are the Symptoms?

How Are Diverticulitis and Diverticulosis Diagnosed?

How Are Diverticulitis and Diverticulosis Treated?

It’s easy to get the care you need.

A comparison of diverticulitis in Crohn’s disease versus ulcerative colitis – Persaud – 2019 – JGH Open

Introduction

Methods

Results

Discussion

Conclusions

Acknowledgments

What is diverticular colitis? – ScienceDirect

Summary

Key words

Recommended articles

Citing articles

Causes, symptoms, risk factors, and complications

Ulcerative colitis vs. diverticulitis: U.S. prevalence

Comparing ulcerative colitis and diverticulitis – signs and symptoms

Difference between ulcerative colitis and diverticulitis causes

Diverticulitis vs. ulcerative colitis: Risk factors and complications

Diagnosis for ulcerative colitis and diverticulitis

Differentiating ulcerative colitis and diverticulitis treatment

Ulcerative Colitis in Association with Diverticular Disease of the Colon

Diverticulosis or Diverticulitis: What’s the Difference?

Diverticula: Small Sacs Along the Intestine Wall

You Can Have Diverticulosis and Not Know It

Diverticulitis Is a Complication of Diverticulosis

Treating Diverticulosis and Diverticulitis

What is colitis?

Main causes

Crohn’s disease

Clinical presentation

Diarrhea

Fibrostenotic disease

Fistulizing disease

Local complications of Crohn’s disease

Morphology

Diagnosis