Diverticulitis Disease

Introduction:

Small out-pouchings called diverticula develop along the intestinal tract. Diverti-
culosis is the condition of having these diverticula. Any part of the large or small
intestine may be involved. The area of the intestinal tract that most commonly
develops diverticula is the lower portion of the large intestine. Certain types of
undigested foods can become trapped in the pouches of the intestine. Bacteria mul-
tiply in the area, causing further inflammation. Diverticulitis is an inflammation of
at least one of the diverticula. Diets that have a low fiber content, seeds, or nuts
have been implicated in the development of diverticulitis. Perforation of the diver-
ticula is possible when they are inflamed.

PROGNOSIS

Inflammation in diverticulitis increases the risk of perforation of the intestine.
Peritonitis will develop from bacterial contamination after perforation of a diver-
ticula. Bleeding from the intestinal mucosa in the area of inflammation can also
occur. The presence of diverticula and repeated periods of inflammation may allow
development of fistula formation from the diverticula to other areas within the
abdomen, such as the intestine or bladder. Patients needing surgery may have a
colostomy postoperatively. Depending on the location of the diverticulitis and the
reason for the surgery, the colostomy may be reversible after healing has occurred.


SIGNS AND SYMPTOMS

• Asymptomatic in diverticulosis
• Change in bowel habits
• Bloating, increased gas
• Abdominal pain most often in the left lower quadrant with diverticulitis
• Rectal bleeding due to inflammation with diverticulitis
• Fever with diverticulitis
• Nausea, vomiting
• Tachycardia due to fever
• Peritonitis if diverticula ruptures

TREATMENT

• Administer antibiotics:
• ciprofloxacin
• metronidazole
• trimethoprim-sulfamethoxazole
• Administer adequate intravenous hydration.
• Manage pain as needed.
• NPO or clear liquids (depending on order) during acute inflammation to rest
intestinal tract.
• Surgical intervention to correct perforation of diverticula, abscess formal-
tion, bowel obstruction, fistula formation.
• NG tube postoperatively.

NURSING DIAGNOSES

• Acute pain
• Altered bowel elimination
• Disturbed body image

NURSING INTERVENTION

• Monitor vital signs for fever, increased heart rate, and decreased blood pressure.
• Assess abdomen for distention, presence of bowel sounds.
• Monitor intake and output.
• Postoperatively check:
• Stoma at colostomy site
• Wound site for drainage or signs of infection
• Peripheral circulation, swelling due to increased risk of clot formation
• Teach patients:
• Eat low-residue foods during flare-ups.
• Eat high-fiber diet when asymptomatic, fresh fruits and vegetables, whole
wheat breads, bran cereals.
• Avoid laxatives and enemas due to increased irritation and intra-abdominal
pressure.
• Avoid lifting during exacerbation.
• Avoid eating nuts and seeds.