DIVERTICULITIS

Submitted to: Ma’am Paloga

Submitted by: Lovely Cacapit
DIVERTICULAR DISEASE
DIVERTICULITIS
 is a type of disease that affects your digestive
tract. It's a serious medical condition that causes
inflamed pouches in the lining of your intestine.
These pouches are called diverticula. They
develop when weak spots in your intestinal wall
give way under pressure, causing sections to
bulge out
 May occur as an acute attack or may persist as a
continuing, smoldering infection.
PATHOPHYSIOLOGY
 Diverticula form when the mucosa and submucosal layers of
the colon herniate through the muscular wall because of high
intraluminal pressure, low volume in the colon (i.e., fiber-
deficient contents), and decreased muscle strength in the
colon wall (i.e., muscular hypertrophy from hardened fecal
masses).
 Bowel contents can accumulate in the diverticulum and
decompose, causing inflammation and infection.
 The diverticulum can also become obstructed and then
inflamed if the obstruction continues.
 The inflammation of the weakened colonic wall of the
diverticulum can cause it to perforate, giving rise to irritability
and spasticity of the colon (i.e., diverticulitis)
 In addition, abscesses develop and may eventually perforate, leading to
peritonitis and erosion of the arterial blood vessels, resulting in bleeding.
 When a patient develops symptoms of diverticulitis, MICROPERFORATION of
the colon has occurred
CLINICAL MANIFESTATION
 MILD TO SEVERE PAIN IN THE LEFT LOWER QUADRANT
 NAUSEA
 VOMITING
 FEVER CHILLS
 LEUKOCYTOSIS

If untreated, can lead to

 PERIRONITIS
 SEPTICEMIA
ASSESSMENT & DIAGNOSTIC FINDINGS
 CT with contrast agents – is the diagnostic test of choice for diverticulitis; it
could also reveal abscesses.
 ABDOMINAL X-RAYS – may demonstrate free air under the diaphragm if the
perforation has occurred from diverticulitis.

Laboratory tests:
 COMPLETE BLOOD COUNT – revealing an elevated WBC count &
Erythrocyte sedimentation rate (ESR)

COLONOSCOPY is contraindicated because the risk of perforation in the

presence of local infection may result in sepsis.
COMPLICATIONS
 PERITONITIS
 ABSCESS FORMATION
 FISTULAS
 BLEEDING
 MEDICAL MANAGEMENT
DIETARY MANAGEMENT

 Clear liquid diet- until

inflammation subsides
 High-fiber, low fat
diet- helps increase stool
volume, decrease colonic
transit time and reduce
intraluminal pressure.
 PHARMACOLOGIC MANAGEMENT

For Outpatients:
 REST
 ANALGESIC MEDICATION
 ANTISPASMODIC AGENTS
 ANTIBIOTICS are prescribed for 7-10 days
 A BULK-FORMING LAXATIVE
In acute cases with significant symptoms, hospitalization is required. Often
indicated for those who are older, immunocompromised, or taking corticosteroids.
 Withholding oral intake
 Administering IV fluids
 Instituting nasogastric suctioning if vomiting or distention occurs are used to rest
the bowel movement.
 BROAD-SPECTRUM ANTIBIOTICS: Ampicillin/Sulbactam, Ticarcillin/Clavulanate,
Ertapenem are prescribed for 7-10 days.
 Opioid or other analgesic agents may be prescribed for pain relief
 Oral intake is increased as symptoms subside.
 Low-fiber diet may be necessary until signs of infection decreases.
 ANTISPASMODIC AGENTS: Propantheline bromide and Oxyphencyclimine may be
prescribed
 Probiotics have been suggested as a way to promote prevention of relapse in that
the healthy bacteria may promote a better balance of microbes in the intestine
and augment immune competence.
 SURGICAL MANAGEMENT
If complications (perforation,
peritonitis, haemorrhage,
obstruction) occur, immediate
surgical intervention is necessary
 CT-guided percutaneous
drainage may be performed to
drain the abscess, and IV
antibiotics are administered.
 One-stage resection, in which
the inflamed area is removed and
a primary end-to-end anastomosis
is completed
 Multiple-stage procedures for
complications such as obstruction
or perforation.
NURSING
PROCESS/MANAGEMENT
ASSESSMENT
 During health history, ask about the onset and duration of pain
and about past and present elimination patterns.
 Review dietary habits to determine fiber intake and ask about
straining at stool, history of constipation with periods of diarrhea,
tenesmus, abdominal bloating and distention.
 Auscultate for the presence and character of bowel sounds and
palpation for left lower quadrant pain, tenderness, or firm mass.
 The stool is inspected for pus, mucus, or blood.
 Temperature, pulse, and blood pressure are monitored for
abnormal variations
NURSING DIAGNOSIS ( may include the following)
 Constipation related to narrowing of the colon from
thickened muscular segments and strictures.
 Acute pain related to inflammation and infection

Collaborative problems/potential complications

 Peritonitis
 Abscess formation
 Bleeding
PLANNING AND GOALS
 Attainment and maintenance of normal elimination patterns
 Pain Relief
 Absence of complications

NURSING INTERVENTION
Maintaining Normal Elimination patterns
 Fluid intake of 2L/day (within limits of the patient’s cardiac and renal
reserve)
 Suggest foods that are soft but have increased fiber, such as prepared
cereals or soft-cooked vegetables, to increase the bulk of stool and
facilitate peristalsis, thereby promoting defecation.
 Individualized exercise program is encouraged to improve abdominal
muscle tone.
 Review his/her daily routine to establish a schedule for meals and a set
time for defecation,
 Assist in identifying habits that may have suppressed the urge to defecate.
 Encourage daily intake of bulk laxatives as prescribed

RELIEVING PAIN
 Opioid analgesics to relieve the pain
 Antispasmodic agents to decrease intestinal spasm are administered as
prescribed
 Record the intensity, duration and location of pain to determine whether the
inflammatory process worsens or subsides.

MONITORING AND MANAGING POTENTIAL COMPLICATIONS

 Assess for the following signs and symptoms of perforation: increased abdominal
pain and tenderness accompanied by abdominal rigidity, elevated WBC count,
elevated ESR, increased temp, tachycardia, and hypotension.
 Perforation is a surgical emergency. Monitor vital signs and urine output and
administers IV fluids to replace volume loss as needed.
PROMOTING HOME AND COMMUNITY-BASED CARE
 Remind the patient and family about the importance of continuing health
promotion and screening practices.
 Educate pt who have not been involved in these practices in the past about
their importance and refers the patients to appropriate health care
providers.

EVALUATION
Expected patient outcomes may include:
1. Attains a normal pattern of elimination
a. reports less abdominal cramping and pain
b. reports the passage of soft, formed stool without pain
c. drinks at least 10 glasses of fluid each day
d. exercise daily
2. Reports decreased pain
a. requests analgesic agent as needed
b. adheres to a low-fiber diet during acute episodes
3. Recovers without complications
a. is afebrile
b. has normal BP
c. has a soft, nontender abdomen with normal bowel sounds
d. maintains adequate urine output
e. has no blood in the stool