Diverticulitis Diverticulitis Donna Peters

							Diverticulitis

  Donna Peters
Glossary
 Diverticulum
 Diverticulosis
 Diverticulitis
Incidence
 Commonly found in the sigmoid colon
 Most common pathologic condition(30 million)
 Begin after the age of 35
 Incidence increases with age
 66% over the age of 80
Etiology
 No Known cause
 Rare in high residue diets so it is believed that lack of fiber
  leads to low bulk stool and prolonged transit time.
Pathophysiology
 Increased pressure within the lumen of the bowel which
  forces hernination of the mucosa
 Inflammation spreads around the diverticulum into the
  pericolic fat causing fibrosis and perforation can occur.
  Diagnosis: History
 Assess the patient’s pain:
    Onset
    Type
    Location
    Intensity
 Review diet for last 24 hours
 Assess elimination pattern
    Constipation then diarrhea
    Fever chills, fatigue
Diagnosis: Assessment
 LLQ-crampy/constant and radiate to the back
 Constipation alternating with diarrhea
 Abdominal distention
 Palpation: sausage-shaped mass LLQ
 Fever, leukocytosis, chills, N/V
                         Chronic Diverticulitis




       Stricture          Pericolic abscess        Abscess
     may lead to            may lead to           May lead to
Intestinal Obstruction          fistula           perforation
Diagnosis: Labs
 CBC - Leukocytosis
 Colonoscopy-
 Barium enema
 Stool for occult blood
 Acute diverticulitis
   X-ray – free air
   Use CT Scan
     No barium enema
     No colonoscopy
Management
 Prevent
   High fiber diet
   Bulk forming laxative - Metamucil
   Stool softeners
Acute Management
 Rest & analgesics
 Antibiotics
 NPO/IV fluids
 Bed Rest
 NG suction
 Monitor for:
   Perforation
   Peritonitis
   hemorrhage
 Surgical Intervention
 2 Types
   One Stage – end to end anastomosis
   Multiple stage
     Double barrel
     Hartmann
Patient Education
 Increase bulk forming laxatives
 Exercise
 Avoid enemas
 Avoid nuts, popcorn, celery
Nursing Diagnosis: Constipation
 Patient passes formed stool    High fiber diet
  daily                          Exercise
                                 Drink 8 – 10 glasses
                                 Avoid
                                   Nuts
                                   Seeds
                                   Celery
                                   Popcorn and more
In contrast to Diverticulitis, the patient
with diverticulosis
A. Has rectal bleeding
B. Often has no symptoms
C. Has localized crampy pain
D. Frequently develops peritonitis
Peritonitis
 Inflammation of the pertioneum
 E-coli, klebsiella, proteus, pseudomonas
 Causes
   Appendicitis
   Perforated ulcer
   Diverticulitis
   Bowel perforation
   Surgery
   Peritoneal dialysis
Clinical Manifestations
 History:
   Pain
 Assessment
   Rebound tenderness
   Board like abdomen
   Paralytic ileus
 Diagnostic
   WBC
   X-ray
   Peritoneal aspiration with c/s
Medical Management
 NPO
 Fluid, colloid and electrolyte replacement
 Analgesics
 Antibiotics
 Surgery
 Monitor complications
   Shock
   Abscess
   Dehiscence