Diverticulosis and Diverticulitis
Signs and Symptoms of Diverticulitis
Pain in abdomen...mainly in the left lower quadrant Observe abdominal bloating and blood in stool Unrelenting cramping type pain Constipation High temperature
diagnosed
Colonoscopy CT scan of the abdomen with contrast
Complication of Diverticulosis
Diverticular Bleeding....why? Surrounding the diverticulum are arteries that supply the intestinal wall. Overtime, these walls thin and the arteries become very superficial within the diverticulum wall. The artery wall can become weak overtime and eventually lose integrity which leads to GI bleeding or the diverticulum ruptures. Many patients will experience painless bleeding and bright blood in the stool/rectum.
Nursing Interventions for Diverticulitis
Monitor GI system and diet status closely: During initial phase of moderate to severe diverticulitis...physician may prescribe IV antibiotics (oral if case is mild) to kill the infection and diet will be NPO...bowel rest so healing can begin. MD may order TPN/IV fluids or fat emulsions to help with nutrition Nurses role: administering medications, monitoring weights/hydration status, vital signs, signs of peritonitis...abdominal pain/tenderness, unrelenting fever, bloating, increased HR, RR), administering pain medication for abdominal pain As signs and symptoms decrease: advance patient's diet per MD order to clear liquids and then low-fiber foods (NOTE: this is the only time a person with diverticulosis needs to consume a low-fiber diet) Clear liquids are anything that are clear that you can see through like Jello, broths, apple juice etc. Low-fiber foods: White rice, cooked fruits or vegetable without seeds or skin, eggs...Why no high-fiber foods yet? Bowel needs to rest and work very little...low-fiber foods allow this to happen. Once recovered: needs to consume high fiber foods (fresh fruits and vegetables, beans, oats and other grains)...keeps stools soft and bulky...decreases episodes of constipation Drink plenty of fluids (2-3 L) to keep hydrated as tolerated (of course patients with heart failure and renal failure need to watch fluid intake per MD order) Goal to avoid constipation: MD may prescribe Psyllium (Metamucil)...mix in 8 oz water and have the patient drink it. Psyllium works by absorbing water from the intestine which in turns makes stool easier to pass (softer and bulker) Probiotics It was once thought that patients with diverticulosis should avoid seeds, nuts etc. but now research is showing patients do not have to avoid seeds (pumpkin, sunflower), nuts, fruit/veg with seeds unless they are intolerant to them already.
Signs and Symptoms of Diverticulosis
Patients are usually asymptomatic until they develop a complication. If a patient does have signs and symptoms they may experience: change in bowel pattern (sudden constipation/diarrhea) abdominal bloating *The patient may attribute these signs and symptoms to something else. Many patients find out they have this disease at random. For example, they have a lower GI series performed for another reason and they find out they have multiple diverticula in the sigmoid colon OR the patient experiences a complication of diverticulosis
A patient asks what type of testing is performed to assess for diverticulosis. As the nurse, you know that which test below is used to assess for diverticulosis?* A. Colonoscopy B. Fleets enema C. Bronchoscopy D. Cystoscopy
The answer is A. This is the only option that can assess for diverticulosis.
Most patients with diverticulosis are most likely to have diverticula located in the?* A. Transverse colon B. Sigmoid Colon C. Rectum D. Ascending Colon
The answer is B: sigmoid colon. Diverticulosis can occur throughout the GI tract, however, it tends to be most common in the sigmoid colon.
A patient with a history of diverticulosis is admitted with abdominal pain. The physician suspects diverticulitis. What other findings would correlate with diverticulitis? SELECT-ALL-THAT-APPLY:* A. Abdominal pain that is mainly present in the upper right quadrant B. Unrelenting cramping type pain C. Pain found at McBurney's Point D. Blood in stool E. Fever F. Reports of constipation G. Abdominal bloating H. Positive Cullen's Sign
The answers are : B, D, E, F, and G. These are typical signs and symptoms found with diverticulitis. Option C is found in appendicitis and Option H is found in acute pancreatitis. Option A is wrong because abdominal pain is typically found in the left lower quadrant not upper right.
Causes of Diverticulosis
increased pressure in the colon due to constipation/straining during bowel movements which is most likely due to consuming a diet low in fiber. Low fiber diets don't bulk the stool like high-fiber diets. Instead, the stools are smaller and drier. This requires the intestines to work harder to push the stool through the system and out the anus. Due to this, certain areas of the intestinal wall start to herniate overtime. Increases with age and tends to run in families
Diverticulitis
inflammation of a diverticulum
fistula
intestinal wall weakens so much that it creates an opening that acts as a channel or passage to other organs, such as another intestine or another organ. Most common type of fistula with diverticulitis/osis is colovesicular (fistula from intestine to bladder).
What is Diverticulosis
the formation of hollow sac cavities throughout the intestinal wall. These outpouching sacs can form anywhere throughout the intestine but are most commonly found in the sigmoid colon of the large intestine.
Main Points about Diverticulosis
A person can have many of these outpouching areas which are called diverticula or a single one which is called diverticulum. Typically, when a patient has a single diverticulum they are at risk for developing more herniated sac areas.
Complications of Diverticulitis
Abscess: herniated pouch becomes full of infection and is swollen with pus. Patient will have major symptoms (fever, high WBC, intense abdominal pain, nausea, fever) Rupture of Diverticulum: sac tears open and spills it contents into the abdominal cavity. This leads to peritonitis. Obstruction due to the inflammation of the tissue or scarring of the tissue Fistula formation
treatment
Most cases are treated with IV or oral antibiotics and bowel rest with slow introduction of foods as signs and symptoms decrease. Drainage of the abscess in the affected diverticulum For reoccur cases: Partial colectomy (bowel resection): remove diseased portion of the colon....if multiple surgeries are required where healthy bowel cannot be reconnected right away the patient may need a temporary colostomy until it heals and then it will be reconnected.
What causes Diverticulitis
Not all people who have diverticulosis will develop diverticulitis Possibly due to stool getting stuck in the herniated pouches due to straining/constipation. Patients who consume low fiber diets have hard stools that stay in the colon longer. These stools are harder to push out which increases pressure in the intestine and this leads to the stool getting stuck in the out-pouching. Another possibility: The increased pressure in the colon causes a tear in the diverticulum which leads to infection and inflammation. This allows bacteria to migrate in the out-pouching and cause infection.
A patient is experiencing an acute episode of diverticulitis. The patient is having abdominal pain, temperature 102.6 'F, and elevated WBCs. As the nurse, you know it is important to:* A. Encourage intake of high-fiber foods B. Monitor the patient for peritonitis C. Apply a heating pad to the patient's abdomen to help alleviate pain D. Encourage intake of full liquids
The answer is B. The patient experiencing an episode of acute diverticulitis is at risk for abscess due to the presenting infection in the affected pouch/pouches which can lead to peritonitis if the abscess ruptures. Therefore, the nurse should monitor the patient for signs and symptoms of peritonitis which include: increased HR, RR, abdominal tenderness/bloating, and high fever.
In regards to question 5, this patient signs and symptoms are starting to subside. Which of the following food items would be best for the patient to consume?* A. Oatmeal and bran B. Orange juice and eggs C. Chicken broth and Jello D. Salad with chicken
The answer is C. During the recovery phase of diverticulitis, once the symptoms start subsiding, the patient should start out with clear liquids like broth, jello, ice etc. and then low-fiber foods until healed. After the patient has fully recovered, they should consume a high-fiber diet and stay hydrated.
You're providing discharge teaching to a patient who was hospitalized with diverticulitis. Which statement by the patient requires you to re-educate the patient?* A. "It is important I consume a diet high in fiber and keep hydrated to keep my stool soft." B. "The physician prescribed me to take Psyllium every day which will help prevent constipation." C. "I will be sure to always cook and skin my fruits and vegetables rather than eating them fresh." D. "I will notify my physician if I develop abdominal pain and fever."
The answer is C. The patient should consume fresh fruits and vegetables because they contain the most fiber. Fruits and vegetables that have been skinned or cooked have low amounts of fiber in them. The patient needs to follow a high-fiber diet..not low-fiber. A low fiber diet is only followed when the patient has experienced an episode of diverticulitis and is not fully healed from the inflammation.
You're providing nursing education to a group of nursing students about diverticulosis versus diverticulitis. Which statement by the nursing students demonstrate they understand the education provided? A. "Most patients with diverticulitis are asymptomatic." B. "Diverticulosis tends to occur in young women with a family history of diverticulosis." C. "Diverticulitis, if not treated, can lead to abscess formation and peritonitis." D. "Patients with diverticulosis should at all times avoid eating seeds and nuts."
The answer is C. This statement is the only true statement. Option A is wrong because patients with diverticulOSIS (not diverticulitis) are usually asymptomatic. Patients with diverticulitis will have symptoms of cramping like abdominal pain which is mainly felt in the left lower quadrant, blood in stool, constipation, fever. Option B is wrong because diverticulosis tends to occur in middle to older-aged adults not young. Option D is wrong because research now shows that consuming seeds or nuts does not cause diverticulitis as it was once thought.
True or False: Most patients with chronic diverticulitis require surgery at some point, such as a bowel resection. If the healthy bowel cannot be reconnected right away, a permanent colostomy will be created until it can be reconnected.*
The answer is False. Most patients with chronic diverticulitis require surgery at some point, such as a bowel resection. If the healthy bowel cannot be reconnected right away, a TEMPORARY (NOT permanent) colostomy will be created until it can be reconnected.
Strictures/bowel obstruction
narrowing of the bowel wall that leads to bowel obstruction. This can be due to chronic episodes of diverticulitis or the presence of acute inflammation. Fecal matter or food can get stuck in this narrowing which causes obstruction.