Exam 2: Chapter 47 - Diverticulitis Flashcards
What is diverticulum?
A saclike herniation of the lining of the bowel that extends through a defect in the muscle layer
Where is Diverticula most common?
Can occur anywhere in GI tract, but most common is colon particularly in the sigmoid colon
What is Diverticulosis?
Defined by the presence of multiple diverticula wihtout inflammation or symptoms
Risk Factors of Diverticulosis?
Low intake of dietary fiber,
obesity,
history of cigarette smoking,
regular use of NSAIDs
positive family history
What is Diverticulitis?
When a diverticulum becomes inflamed, causing perforation and potential complications such as obstruction, abscess, fistula, peritonitis, and hemorrhage.
Diverticula form when
Form when the mucosal and submucosal layers of the colon herniate through the mucular wall because of high intraluminal pressure, low volume in the colon, and decreased msucle strength in the colon wall. Bowels content can accumulate in the diverticulum and decompose, causing inflammation and infection
What happens in Diverticular Disease?
Sacs are enlarged. This could be because a piece of corn got stuck in there and caused damage to the diverticulum.
What pain do patients report in diverticulitis?
Up to 70% of patients report an acute onset of mild to severe pain in the left lower quadrant.
Acute complications of diverticulitis?
Abscess formation, bleeding, and peritonitis.
If abscess develops, the associated findings are tenderness, palpable mass, fever, and leukocytosis.
Inflamed diverticulum that perforates results in abdominal pain localized over the involved segment, usually the sigmoid
Chronic complications of diverticulitis include
fistula formation, colovesicular fistulas, colovaginal fistulas.
This leads to a colon that may narrow with scar tissue and fibrotic strictures
Diverticulosis is typically diagnoses by
colonscopy, which permits visualization of the extent of diverticular disease
Laboratory tests for diverticulosis include
CBC, revealing an elevated white blood cell count.
What is the test of choice to confirm diverticulitis?
An abdominal CT scan with contrast agent. It can also reveal perforation and abscesses.
Abdominal X Rays may demonstrate
free air under the diaphragm if a perforation has occured from the diverticulitis
Results from radiologic tests confirm
whether or not the patient has uncomplicated diverticulitis or complicated diverticulitis that require surigcal inntervention
Treatment for patients with uncomplicated diverticulitis include
an outpatient basis with diet and medication. Rest, oral fluids, and analgesic emdications.
This is for 80% of patients
Diet when you have inflammation?
Clear liquid diet is consumed until inflammation subsides; then a high fiber low-fat diet is recommended.
diet when you have acute diverticulitis
Withhholding oral intake, administering IV fluids, and instuting nasogastric suctioning if vomiting or distention occurs are used to rest the bowels. Antibiotics may be prescribed for pain relief. In these cases, the patient is hospitialized
Symptoms of Diverticular Disease?
Alternating Diarrhea with Constipation Pain LLQ Nausea Vomiting Fever Chills
Potential Complications?
Perforation
Peritonitis
Absecess Formation
Bleeding
Two types of surgery considered?
One-Stage REsection (Inflamed area is removed and a primary end-to-end anastomsis is completed)
Multiple-stage procedures for complications such as obstruction or perforation
When possible, the area of diverticulitis is resected and the remaining bowel is joined end to end.
Two stage resection may be performed in patients with Hinchey Stage IV.
Fluid and food intake recommendation?
2 L/day of liquid
Foods that are soft but have increased fiber (prepared cereals or soft-cooked vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation)
What does a X-Ray show for this disease?
SHows if there is any free air. Air can get into the abdominal cavity.
