Diverticulitis

A Research Paper Presented to the College of Health Adventist University of the Philippines

In partial fulfillment for the course Nutrition and Diet Therapy Summer 2013

Submitted by: Uriel Maravilla Bernadas

I.

Introduction A. Importance of the Study This case study is focused on preterm labor and endeavors to address the need of every nursing student to understand its probable causes, its process of occurrence, its manifestations, proper treatments to utilize, and how to prevent acquiring diverticulitis. And may help in enhancing the nursing care for the client having or experiencing diverticulitis. B. Objectives At the end of the research presentation, the student will be able to: a) Identify risk factors of the disease; types of individuals, and the conditions that may cause the acquisition of the disease. b) Enumerate the diagnostic tests appropriate in the identification of the condition. c) List medical nutritional therapy that may be prescribed for treatment. d) Identify methods how to prevent acquiring the diverticulitis. e) List nursing interventions appropriate for alleviating the manifestations of diverticulitis. f) Briefly discuss the pathophysiology of diverticulitis.

II.

Theoretical Considerations A. Definition Diverticulitis is a common digestive disease which involves the formation of pouches Importance (diverticula) within the bowel wall. This process is known as diverticulosis, and typically occurs within the large intestine, or colon, although it can occasionally

occur in the small intestine as well. Diverticulitis results when one of these diverticula becomes inflamed. Diverticulitis is generally considered a disease of the elderly, but as many as 20% of patients with diverticulitis are younger than 50 years. B. Etiology Doctors aren't sure what causes diverticula in the colon (diverticulosis). But they think that a low-fiber diet may play a role. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon. Diverticulitis happens when feces get trapped in the pouches (diverticula). This allows bacteria to grow in the pouches. This can lead to inflammation or infection. Diverticula form most commonly in the esophagus, small intestine, and large intestine and are most often a problem in the latter organ. Middle-aged and older people are particularly susceptible to the condition because of the inevitable weakening of the muscle walls of the colon with advancing age. C. Pathology Diverticula in the colon may be caused by increased pressure inside the colon that presses outward on the walls. Areas where blood vessels enter the walls of the colon are points of weakness and more likely to be points where diverticula form. The increased pressure, combined with decreased strength of connective tissue causes parts of the wall to bulge out. This is a condition called diverticulosis that usually does not Once diverticulosis occurs, these outpouchings can become blocked, inflamed and infected, which is the condition known as diverticulitis. The colon contains many

bacteria

that

can

infect

the

diverticula.

Diverticulitis often causes pain in the left-lower area of the abdomen and fever. A blood test shows high white cells, which is a marker of inflammation and infection. Nausea, vomiting and changes in bowel habits also can occur. A computed axial tomography, or CT or CAT, scan is generally the next step to establish the diagnosis.

D. Incidence No one knows exactly what causes the sacs, or pouches of diverticulosis to form. Eating a low-fiber diet is one of the most likely causes. People who eat mostly processed food, as many Americans eat, do not get enough fiber in their diet. Processed foods include white rice, white bread, most breakfast cereals, crackers, and pretzels. As a result, constipation and hard stools are more likely to occur - causing people to strain when passing stools. This increases the pressure in the colon or intestines and may cause these pouches to form. Diverticulosis is very common. It is found in more than half of Americans over age 60. Diverticulitis is caused by small pieces of stool (feces) that become trapped in these pouches, causing infection or inflammation. E. Clinical Manifestations 1. Initial Complaints While the prevalence of diverticulosis is high, only 20% of afflicted people are ever symptomatic. The most common symptom is colicky left lower quadrant pain thought to be due to acute increase in intraluminal pressure. The most common complication is diverticulitis which is accompanied by left lower pain, fever and

often tenderness. Presence of a palpable mass indicates abscess formation. Other bowel symptoms are usually present but are variable. Minor blood loss commonly occurs in diverticular disease, but severe acute blood loss occurs in 3-5% of afflicted people. It is the most common cause of massive lower GI hemorrhage. Recurrent episodes of diverticulitis may lead to extensive focal scarring and signs of obstruction. Most people with diverticulosis are asymptomatic or have mild disease and overall only 1% will require hospitalization. People with diverticulosis often have no symptoms, but they may have bloating and cramping in the lower part of the belly. Rarely, they may notice blood in their stool or on toilet paper. Symptoms of diverticulitis are more severe and often start suddenly, but they may become worse over a few days. Symptoms of diverticulitis may last from a few hours to a week or more. Symptoms include: Belly pain, usually in the lower left side, that is sometimes worse when you move. This is the most common symptom. Fever and chills. Bloating and gas. Diarrhea or constipation. Nausea and sometimes vomiting. Not feeling like eating.

2. Laboratory Test Data Laboratory tests may be of help when the diagnosis is in question, as follows: The white blood cell count may show leukocytosis and a left shift, but may be normal in immunocompromised, elderly, or less severely ill patients.

A hemoglobin level is important in patients who report hematochezia Electrolyte assays may be helpful in the patient who is vomiting or has diarrhea Renal function is assessed prior to the administration of most intravenous contrast material

Your health care provider will examine the patient. Blood tests may be ordered to see if the patient has an infection. Other tests that help diagnose diverticulitis may include: CT scan, Ultrasound of the abdomen, and X-rays of the abdomen. Computed tomography (CT) scanning of the abdomen is considered the best imaging method to confirm the diagnosis. Sensitivity and specificity, especially with helical CT and colonic contrast, can be as high as 97%.

3. Complications In complicated diverticulitis, bacteria may subsequently infect the outside of the colon if an inflamed diverticulum bursts open. If the infection spreads to the lining of the abdominal cavity, (peritoneum), this can cause a potentially fatal peritonitis. Sometimes inflamed diverticula can cause narrowing of the bowel, leading to an obstruction. Also, the affected part of the colon could adhere to the bladder or other organ in the pelvic cavity, causing a fistula, or abnormal connection between an organ and adjacent structure or organ, in this case the colon and an adjacent organ. Bowel obstruction Peritonitis Abscess Fistula Bleeding Strictures