Diverticular disease 1077-1081 Diverticulum – saclike herniation of lining of bowel that extends thru muscle layer.

Most common in sigmoid colon, but can occur anywhere in small intestine or colon. Asians develop diverticula in right colon b/c genetic. Diverticulosis- multiple diverticula present w/o symptoms or inflammation. More than 50% of americans over 80 have this. Low fiber intake is reason. Most asymtomatic. Diverticulitis- occurs when food and bacterai in diverticulum and infection. Can be acute or persistent. Usually from complication such as fistual (abnormal tract), obstruction or perforatino. Diverticula occurs when mucosa and submocosal layers of colon go thorugh muscular wall b/c of high pressure and low volume (low fiber) in colon wall. Spasticity of colon, Results in ersoion of arterial blood vessels and bleeding. Signs and symptoms- chronic constipation for many years. Bowel irregualrity with interval sof diarrhea, nausea and anorexia, bloating and abdominal distention. If repeated leads to cramps, narow stools, increased constipation. Weaknss, fatigue and anorexia common. Mild to severe pain in LLQ, with n/v, fever, chils and leukocytosis. If worse peritonitis and septiciemia. Diagnosing- mainly by colonoscopy. Used to be barium enema, . CT with contrast is test of choice if suspected dx is diverticulitis. It reveals abcesses as well. Abdominal xray shows air under diaphragem. Lab tests are CBC, with high WBC and high ESR. Complications-peritonitis, abcess, fistula, bleding. Abcess -tenderness, palpable mass, fever and leukocytosis. Pain over sigmoid colon. Ab pain, rigid boardlike ab, loss bowel sounds, s/s shock. Fistula b/w bowel and bladder, rectal bleeding. Gerontologic considerations- less pronounced , maynot mhave ab pain until infection, delay b/c fear of cancer, don't examine their own stool or can't see it well. Medical Management- diet and meds. Analgesics, antispasmodic. Clear liquid diet until inflammation subsides. Then high fiber, low fat . This increses stool volume. Bulk forming laxatives as well. Antibiotics for 7-10 days if in hospital, Demerol (meperdine) for pain not Morphine b/c can increase pressure in colon. Low fiber if in hospital until infection signs decrease. Antispasmodics such as Daricon or propranteheline bromide. Psyllium or stool softener (docusate), oil in rectum, evacuant supposiotry (bisacodyl). It reuces bactera in bowel, diminishes bulk of stool and softens pooh so that can move easily . Surgical management- CT guided percutaneous drainage, after 6 weeks, surgery recommended. 2 types, A)one stage resection- inflamed area removed , primary end to end anastomosis *if possible. B) multiple stage procedure for obstruction or perforation.

ab bloating. increase fiber. oil retention enema. high esr. cereal. auscultation of bowel sounds and palpate LLQ for pain. stool softener . diarrhea. tender ab rigid.fluid 2L day.and antispasmodic agent . . hypotension. stool inspect for blood .opiod analgesics such as meperdine -demerol. exrcise. . soft cook veggies. .Nursing process Assessment. pus. tachy. N/I maintaining normal elimination patterns. Releive pain. distensiton. Potential complication management-s/s of perforation include increased ab pain. mucus. tenderness and firm mass. fier. stool strain. Perforation is surgical emergency. constipatin. No nuts and popcorn. time for meals and defecation. high wbc.onset. high temp. bulk lax such as psyllium. duratin. Monitor vials and urine output and iv fluids.

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