DIVERTICULOSIS AND DIVERTICULITIS P 1046 1047 Diverticula are saccular dilations or outpouchings of the mucosa that develop in the colon at points where the vasa recta penetrate the circular muscle layer Diverticulosis diverticula are present but they are NOT inflamed Diverticulitis diverticula ARE inflamed which results in perforation into the peritoneum Ranges from asymptomatic to uncomplicated diverticulosis to complicated diverticulitis o Complications perforation abscess fistula and bleeding Most commonly found in the sigmoid colon but can occur anywhere throughout the GI tract ETIOLOGY Right colon diverticula ascending most common in Asian population Left colon diverticula descending sigmoid most common in Western populations o Associated with high luminal pressures from a fiber deficiency Uncommon in vegetarians Cause unknown o May be because of high interluminal pressures on weakened areas of the bowel wall Precipitating factors vomiting straining bending lifting and tight restrictive clothing CLINICAL MANIFESTATIONS Diverticulosis is usually asymptomatic o But can have abdominal pain bloating flatulence and change in bowel habits 25 of patients with diverticulosis will have a period of acute diverticulitis Diverticulitis usually has pain over the affected area of the abdomen o Fever leukosytosis and a palpable mass o Elderly patients usually are afebrile with normal WBC and little tenderness Complications o Peritonitis o Abscess and fistula formation o Obstruction o Bleeding DIAGNOSTIC Abdominal and chest radiographs rule out CT scan with oral contrast test of choice Sometimes found during routine colonoscopy and sigmoidoscopy History and physical examination Occult blood stool test Urinalysis Barium enema CBC Blood culture NURSING AND COLLABORATIVE MANAGEMENT Conservative o High fiber diet or supplements Fruits and vegetables Decrease intake of fat and red meat Avoid nuts and seeds is under investigation o Stool softener o Anticholinergics o Mineral oil o Bed rest o Clear liquid diet o Oral antibiotics o Bulk laxatives o Weight reduction if over weight o Increase physical activity Acute Care for Diverticulitis let colon rest o Antibiotic therapy o NPO status o IV fluids o Possible resection of involved colon for obstruction or hemorrhage o Possible temporary colostomy o Bed rest o NG suction Surgery only for complications abscess or obstruction o Resection of the involved colon with either anastomosis or temporary colostomy Patient teaching about the disease is important to increase adherence
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