Unit 3: Diverticulitis Flashcards
Diverticulum
small, pouchlike protrusion or herniation
-most often in GI tracts, particularly the colon
What is Diverticulitis related to?
- lack of fiber in the diet
- obesity
- lack of physical activity
Risk Factors For Diverticulitis
- increasing age
- obesity
- smoking
- low-fiber diet
- heredity
- mediations (NSAIDs, acetaminophen. oral corticosteroids, and opiates)
- association w/ eating red meat and high-fat diets
Diverticulitis and Whole Fiber
do not consume whole piece of fiber; seeds, corn, and nuts
-these undigested fragments can become lodged in the diverticulum and induce an episode of diverticulitis
Pathophysiology of Diverticulitis
- generally extraluminal, occurring on the outside of the colon; “outpouching”
- often occurs in the colon; sigmoid colon
- when a patient has diverticula, the colon wall thickens and becomes rigid
- w/o adequate fiber intake, more water is absorbed from the stool; this slows transit time, makes it more difficult for the stool to pass through the colon
- this causes increased intraluminal pressure from constipation and straining, which is thought to lead to the formation of diverticula
- diverticula seem to occur at points of weakness in the intestinal wall
- food can become entrapped in the diverticula, and when it mixes with normal bacterial flora, this leads to a decreased bloody supply, forming a mass called fecalith or dried, hard, concrete-like stool
- the diverticular wall is eroded by increased intraluminal pressure or hard, dried food particles
- this process leads to inflammation and/or infection; this inflammation can spread to other areas of the intestine
Diverticulitis
an inflammation and/or infected diverticula
-often occurs in sigmoid colon
Chronic Diverticulitis
the bowel can become scarred, leading to narrowing of the lumen, which may result in intestinal obstruction
Diverticulosis
presence of diverticula that are not inflamed
- asymptomatic
- patients may not even know they have the condition
Clinical Manifestations
- abdominal pain over the area that is involved
- fever or leukocytosis (High WBC)
- palpable mass in involved area
- complain of increased flatus, anorexia, abdominal bloating/distention, diarrhea or constipation
- stool contains mucus and blood; bleeding occurs b/c of inflammation near areas of blood vessels and can range from minor to severe
Clinical Manifestations in the Older patient
- may be afebrile with a normal WBC count and minimal abdominal tenderness
- change in mental status is the first sign
- may present w/ increased confusion, falling, and anorexia
- if perforation occurred, may present w/ signs of sepsis
- if pain is more generalized over abdomen, peritonitis may have developed; displays profound guarding w/ widespread rebound tenderness
Diagnosis
- plain flat-plate abdominal x-ray
- confirmed with CT scan
- WBCs monitored for elevations initially associated w/ inflammation and possible infection but should decrease w/ treatment
- Urinalysis may show a few RBCs if ureter is near a perforated diverticulum
- should NOT have barium enema; risk of rupturing diverticula
What Diagnostic Test is contraindicated with Diverticulitis
Barium Enema
-risk of rupturing diverticula
Treatment for Uncomplicated Diverticulitis
- outpatient basis
- broad-spectrum antibiotics for 7 to 10 days but reassessed after 2-3 days of therapy
- no dietary restrictions but clear liquid diet for 2-3 days until symptoms subside, then advanced slowly as tolerated
When should the patient be admitted to the hospital?
- fever higher than 102.5 Degrees F (39* C)
- microperforation (few air bubbles outside the colon or confined to the pelvis)
- immunosuppression
- significant leukocytosis
- severe abdominal pain or diffuse peritonitis
- advanced age
- significant comorbidities
- intolerance of oral intake
- noncompliance or failed outpatient treatment
Common Antibiotics used
- Ciprofloxacin and metronidazole
- Amoxicillin-clavulanate
- Augmentin or Moxifloxacin
