Diverticular Disease

Clinical manifestations of Diverticulitis?

-Acute onset, mild to severe pain LLQ -N/V -Fever, chills, and leukocytosis -If untreated, can lead to peritonitis and septicemia

Clinical Manifestations of Diverticulosis?

-Asymptomatic -Bowel irregularity, diarrhea -Nausea, anorexia, Bloating, abdominal distention -Repeated inflammation... large bowel may narrow (fibrotic strictures), cramps, narrow stools, constipation (obstruction) -Weakness, fatigue

Assessment and Diagnostic Findings for Diverticular Disease?

-Colonoscopy is contraindicated in acute diverticulitis because the risk of perforation in the presence of local infection may result in sepsis. Colonoscopy - Visualization, biopsy Barium enema - Used less frequently than colonoscopy - Potential for perforation ** CT with contrast agent Abdominal x-ray CBC, ESR

Management: Uncomplicated Diverticular Disease?

-Fluid intake 2 L/day (within limits of patient's cardiac and renal reserve) -Foods with increased fiber (increase bulk of stool, facilitate peristalsis and defecation) -Exercise to improve abdominal muscle tone; schedule time for meals and defecation -Bulk laxatives (propels feces through colon) -Stool softeners (decrease straining at stool, decrease intestinal pressure) -Oil retention enemas (softens stool, easier to pass stool) -Identify food triggers (nuts, popcorn) and avoid them

Management: Acute Diverticulitis?

-Hospitalization, Assessment (monitoring and managing potential complications) -Rest, NPO (bowel rest), IVF's (Hydration), NG suction (If vomiting or distention, to rest the bowel) -Antibiotics (7-10 days), Opioid (oxycodone) -Oral intake increased as symptoms subsides. A low-fiber diet may be necessary until signs of infection decrease. Antispasmodics -Normal stools can be achieved by supplementing dietary fiber, using bulk preparations, stool softeners, oil retention enemas, or evacuant suppository -Probiotics (to promote prevention of relapse in that healthy bacteria may promote a better balance of microbes in intestine and augment immune competence)

Management: Mild Diverticulitis?

-Outpatient treatment with diet and medication -Rest, Analgesics, Antispasmodics (decrease intestinal spasm) -Initially, clear liquid diet, until inflammation subsides. Then, high-fiber, low-fat diet (increase stool volume, decrease colonic transit time, and reduce intraluminal pressure) -Antibiotics (7-10 days), Bulk-forming laxatives

Pathophysiology: Diverticula form when the mucosa and submucosal layers of the colon herniate through muscular wall because of what 3 things?

-high intraluminal pressure -low volume in the colon (fiber-deficient contents) -decreased muscle strength in colon wall (muscular hypertrophy from hardened fecal masses).

Where do Diverticular occur?

Diverticula may occur anywhere in small intestine or colon but most commonly in sigmoid colon (95%).

What causes Diverticulitis?

Diverticulitis results when food and bacteria retained in a diverticulum produce infection and inflammation that can impede drainage and lead to perforation or abscess formation.

Surgical Management?

If complications occur. One-stage resection, Multiple-stage procedures

What is a Diverticulum?

a saclike herniation of the lining of bowel that extends through a defect in muscle layer.

What are complications of Diverticulitis?

abscess, fistula, obstruction, perforation, peritonitis, and hemorrhage

What is Diverticulosis?

when multiple diverticula are present without inflammation or symptoms.