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Lesson 54. Diverticular Disease

1-54. DIVERTICULAR DISEASE

a. Definition. Diverticula are bulging dilatations or "out-pouchings" of the gastrointestinal walls. Common sites are the sigmoid colon, duodenum, and the distal ileum. However, diverticula can occur anywhere along the GI tract, from the esophagus to the anus.

b. Diverticulosis. The presence of asymptomatic diverticula is called diverticulosis. Diverticulosis is sometimes the source of LLQ pain that is relieved by defecation or flatulence. Constipation or diarrhea may also occur. Diverticulosis generally requires no treatment other than dietary modification to prevent irritation of the bowel.

c. Diverticulitis. When diverticula become inflamed or infected, the condition is referred to as diverticulitis. Food and bacteria lodge and harden in the diverticular sac. Inflammation results, followed by infection. Complications include abscess, obstruction, perforation, peritonitis, and hemorrhage.

(1) Symptoms include low grade fever, nausea, gas, abdominal pain, and abdominal rigidity.

(2) Treatment of mild cases of diverticulitis includes antibiotics, antispasmodics, stool softeners, and liquid diet.

(3) Severe cases of diverticulitis, or cases that involve perforation, obstruction, fistula, or peritonitis may require surgical intervention. Colon resection may be necessary to remove the diseased portion of the bowel. A temporary or permanent colostomy may be indicated.

d. Nursing Implications.

(1) Reinforce patient education regarding dietary modification. Increased roughage in the diet may prevent intestinal contents from lodging in the diverticula. Roughage includes grains, fruits, vegetables, and fiber.

(2) When symptoms occur, the patient should immediately alter his diet to one that is bland and nonirritating.

(3) Diet should include adequate fluid intake to avoid constipation. Constipation encourages inflammation of the bowel.

(4) Vital signs and I&O should be monitored closely.

(5) Observe stools for color and consistency.

(6) If surgery becomes necessary, observe routine preoperative and postoperative nursing care procedures.

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