Medical and Nursing Management of Diverticulitis and Diverticulosis

I. Definition

• Diverticulitis - is a condition involving inflammation of diverticula, small saccular herniations int the colonic wall.
• Diverticulosis – exists when multiple diverticula are present without inflammation or symptoms.

II. Risk Factors

Diverticula
• Increased intraluminal pressure
• Low-fiber diet
• Chronic constipation
• Obesity

Diverticulitis
• Bacteria / food trapped in the diverticula
• Inflammation and infection
• Sigmoid colon is the most common site for diverticulitis because of fecal masses that irritate and increase pressure in the colon.

III. Pathophysiology

Diverticula form as the colonic mucosa pushes through the muscular coat at weak points. Increased intraluminal pressure is the apparent precipitating factor. The diverticula gradually fill with undigested food matter and bacteria. As they enlarge, they become more susceptible to irritation and inflammation.

Potential complications:
• Bacterial or fecal contamination of pericolic tissues
• Fistula
• Colonic wall thicken, narrowing the lumen causing acute obstruction
• Peritonitis
• Hemorrhage

IV. Assessment/Clinical Manifestations/Signs and Symptoms

Diverticulosis
• Asymptomatic, multiple diverticula are present without inflammation

Diverticulitis
• Change in bowel habits
• Dull, steady, or episodic pain in the abdominal left lower quadrant or the epigstrium (depending on location of the diverticulitis)
• Rectal bleeding
• Anorexia
• Low-grade fever

Laboratory and diagnostic study findings:
• Complete blood count evaluation may reveal an elevated white blood cell count and elevated sedimentation rate
• Colonoscopy can visualize diverticula and exclude other possible cause
• Barium enema shows narrowing of the colon and thickened muscle masses, this test is contraindicated in cases of acute inflammation because of the possibility of bower perforation.

V. Nursing Management

Provide measures to rest the colon during an acute exacerbation, which results when food or bacteria in the diverticula cause inflammation.
• Administer nothing by mouth
• Administer IV fluids
• Institute nasogastric suctioning
• Keep the client on bed rest

Help restore the client’s normal bowel elimination pattern by administering one or more of the following:
• Bulk laxatives
• Stimulant laxatives
• Stool softeners (typically used for elderly clients because they are gentle and less likely to cause laxative dependence)
• Saline laxatives
• At least 8 oz of water with any agent

Help prevent constipation.
• Encourage daily exercise such as walking, which increases bowel peristalsis.

Teach the client about nursing care.
• Inform the client that all nursing interventions for diverticulitis are aimed at moving the stool through the colon as easily and with as little irritation as possible.

Administer medications, which may include antibiotics, opioid analgesics, and antispasmodics.

Provide return to normal bowel elimination patterns as symptoms subside.
Slowly increase oral intake until the client is drinking six to eight glasses of water daily.

Offer a low-fiber diet until signs of infection decrease; then gradually increase fiber until the client is eating a high-fiber diet. If a high-fiber diet alone prevents constipation, encourage medication with caution, especially in elderly clients.


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