DIVERTICULAR DISEASE

def

A diverticulum is a saclike outpouching of the lining of the bowel that extends through a defect in the
muscle layer. Diverticula may occur anywhere along the GI tract. Diverticulosis exists when multiple
diverticula are present without inflammation or symptoms.

Diverticulitis results when food and bacteri a retained in a diverticulum produce infection and
inflammation that can impede drainage and lead to perforation or abscess formation

Causes

the exact cause is unknown

A congenital predisposition is suspected when the disorder occurs in those younger than 40 years of
age.

A low intake of dietary fiber is considered a predisposing factor,

. muscle spasms or strain

• Pathophysiology

• A diverticulum forms when the mucosa and submucosal layers of the colon herniate through the
muscular wall because of high intraluminal pressure, low volume in the colon (ie, fiber-deficient
contents), and decreased muscle strength in the colon wall (ie, muscular hypertrophy from
hardened fecal masses).

• Bowel contents can accumulate in the diverticulum and decompose, causing inflammation and
infection.

• A diverticulum can become obstructed and then inflamed if the obstruction continues. The
inflammation tends to spread to the surrounding bowel wall, giving rise to irritability and
spasticity of the colon (ie, diverticulitis).

• Abscesses develop and may eventually perforate, leading to peritonitis and erosion of the blood
vessels (arterial) with bleeding.

• Clinical Manifestations

• Chronic constipation

• Signs of acute diverticulosis are bowel irregularity and intervals of diarrhea,

• crampy pain in the left lower quadrant of the abdomen, and a low-grade fever.

• nausea and anorexia, and some bloating or

• abdominal distention .

• With repeated local inflammation of the diverticula, the large bowel may narrow with fibrotic
strictures, leading to cramps, narrow stools, and increased constipation.
 • Weakness, fatigue, and anorexia pain in the lower left quadrant. The condition, if untreated,
can lead to septicemia

• Diagnostic Findings

• ACT scan -is the procedure of choice and can reveal abscesses. Abdomina x-ray - findings may
demonstrate free air under the diaphragm if a perforation has occurred from the diverticulitis.

• barium enema,

• A colonoscopy - may be performed if there is no acute diverticulitis or after resolution of an

acute episode to visualize the colon, determine the extent of the disease, and rule out other
conditions.

• Laboratory tests diagnosis include a complete

• blood cell count, revealing an elevated leukocyte count, and

• elevated sedimentation rate.

Medical management

• Diverticulosis is managed by preventing constipation. With acute diverticulitis, the patient may
be hospitalized for administration of intravenous antibiotics and pain control.

• A nasogastric tube, intravenous fluids, and NPO status

• When the acute period is over, a progressive diet is started. Whether or not perforation occurs,

• Surgical management

• Surgical resection with anastomosis or a temporary colostomy

• Nursing management

• Dietary considerations for a patient with diverticulosis (without evidence of inflammation)

include foods that are soft but high in fiber, such as prunes, raisins, and peas.

• Unprocessed bran can be added to soups, cereals, and salads to give added bulk to the diet.

• Fiber should be increased in the diet slowly to prevent excess gas and cramping. Some health-
care providers recommend avoiding nuts or foods with small seeds that can get caught in
diverticula, such as tomatoes and raspberries, but this has not been shown to prevent
diverticulitis.

• Abdominal distention is monitored and recorded. With diverticulitis, a firm mass may be
palpated in the sigmoid area.

• Vital signs are monitored for fever or signs of septic shock. Intake and output are monitored and
recorded accurate so that appropriate fluid replacement therapy is ordered.

• Monitoring for reduced urinary output, dropping blood pressure, and rising pulse rate can show
fluid volume deficit.
 • If a fever is noted, the patient may be developing

• sepsis. All symptoms are reported to the physician promptly

IRRITABLE BOWEL SYNDROME

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• Irritable bowel syndrome (IBS) is a group of symptoms that occur together, including repeated
pain in your abdomen and changes in your bowel movements, which may be diarrhea,
constipation, or both. IBS is not a disease but rather a functional problem.

• Symptoms may be exacerbated by psychological stress

CAUSES AND RISK FACTOR

• cause is still unknown.

• heredity, psychological stress or conditions such as depression

• anxiety,

• a diet high in fat and stimulating or irritating foods,

• alcohol consumption, and smoking

• Pathophysiology

• IBS results from a functional disorder of intestinal motility. The change in motility may be
related to the neurologic regulatory system, infection or irritation, or a vascular or metabolic
disturbance.

• . The abnormal contractions lead to pattern changes alternating between diarrhea and
constipation. Additionally, there is increased abdominal discomfort or pain.

• Localized prolonged contractions may cause stool to be retained for a long time, causing it to
become hardened as water is absorbed from it.

• There is no evidence of inflammation or tissue changes in the intestinal mucosa.

CLINICAL MANIFESTATION

• alteration in bowel patterns—constipation, diarrhea, or a combination of both.

• Pain, bloating, and abdominal distention often accompany

• this change in bowel pattern.

• The abdominal pain is sometimes precipitated by eating and is frequently relieved by defecation

• Diagnostic Findings
 • Stool studies, contrast x-ray studies,

• proctoscopy may be performed to rule out other colon diseases.

• Barium enema and colonoscopy may reveal spasm, distention, or mucus accumulation in the
intestine

• Manometry and electromyography are used to study intraluminal pressure changes generated
by spasticity

MEDICAL MANAGEMENT.

• A high-fiber and high-bran diet

• Psyllium [Metamucil] or methylcellulose [Citrucel]) help to form softer, larger stools but may
increase other symptoms

• Stress management, behavioral therapy (biofeedback, hypnosis, psychotherapy), and exercise

are helpful in relaxing the bowel as well as contributing to overall health.

• Antidepressants are given to block the brain’s perception of abdominal pain.

• . Antispasmodics such as hyoscyamine or dicyclomine are used in IBS with diarrhea.

• calcium channel blockers decrease smooth muscle spasm, decreasing cramping and
constipation.

NURSING MANAGEMENT

• Diarrhea related to irregular motility of GI tract

• Obtain history including medications regarding diarrhea episodes to help identify cause.

• • Monitor and record stool characteristics, amount, and frequency to plan care.

• • Give antidiarrheal medications as ordered. Controlling diarrhea controls comfort and fluid
balance.

• • Limit caffeine intake as it stimulates intestinal motility.

• • Keep skin clean, dry, and protected with a moisture barrier, such as petrolatum or medicated
ointment, after each bowel movement to protect perianal skin from contact with liquid stools
and their enzymes.

• Constipation related to irregular motility of GI tract

The patient will maintain passage of soft, formed stool every 1 to 3 days without straining.

• • Assess normal pattern of defecation, diet and fluid intake, and medications to help identify
factors contributing to constipation for planning care.

• • Ensure fluid intake, if not contraindicated, of 2 to 3 L per day to prevent hard stools.