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 thecolonis 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。这是结肠炎和憩室炎之间的主要区别。

内容

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.概括

What is Colitis?

结肠的炎症称为结肠炎。这种情况的临床特征因潜在病理而异。

Main Causes

• Ulcerative colitis
• Crohn’s disease
• Antibiotic-associated colitis
• 感染性结肠炎
• Ischemic colitis

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

Diarrheain 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 toosteoporosis, malnutrition and clotting abnormalities
• Formation ofgallstones
• Nephrolithiasis (formation of kidney stones)
• Vitamin B12 malabsorption

Crohn’s disease increases the risk ofcolon cancers,lymphomas和squamous cell carcinomasof the anus.

Morphology

• Macroscopy

结肠的右侧主要受到克罗恩病的影响。有分段的分布lesions。Usually, the rectum is spared.

• Microscopy

There is a transmural involvement with the occurrence of裂缝和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.

管理

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

• 乙状结肠镜检查
• 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
• 恶性变化
• 肛门裂缝和肛门瘘等验尸疾病。

General Complications

• 毒血症
• Anemia
• Weight loss
• Arthritis和uveitis
• 皮肤病学表现，例如脓皮病
• Primary sclerosing cholangitis

管理

Medical Management

开处方具有维生素补充剂和铁的高蛋白质饮食。如果患者表现出严重贫血的临床迹象，则可能需要输血。通常给予洛地酰胺以控制腹泻。根据直肠输注，皮质类固醇的给药会在急性发作中诱导缓解。需要免疫抑制剂（例如英夫利昔单抗）来控制更严重的溃疡性结肠炎攻击。

Surgical Management

仅在以下情况下表明手术干预。

• 不适用于对医疗治疗的反应
• Chronic disease not responding to medical treatments
• 预防恶性变化
• 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 tofibrosisof 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是通过排除其他可能的诊断来鉴定其急性阶段诊断憩室炎的最合适的研究。
• 乙状结肠镜检查
• Colonoscopy
• Barium enema

治疗

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.

• 通过CT诊断核心脓肿。这些脓肿的经皮引流对于避免将来的并发症至关重要。
• 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.

结肠炎和憩室炎有什么区别？

Colitis vs Diverticulitis
结肠的炎症称为结肠炎。	The inflammation of the diverticula in the colon is known as diverticulitis.
Location
This occurs in the colon.	这发生在憩室。

概括– 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.

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References:

1.“溃疡性结肠炎（2）内窥镜活检”用户：KGH - 自己的工作(CC BY-SA 3.0)viaCommons Wikimedia
2。”术中对乙状结肠憩室炎”By Anpol42 – Own work(CC BY-SA 4.0)viaCommons Wikimedia