Exam 2 Diverticular Disease Flashcards
Saclike herniation of the lining of the bowel that extends to muscle
Diverticulum
Diverticulum
Saclike herniation of the lining of the bowel that extends to muscle
occur ___________ small intestine or colon BUT most commonly ______ colon
occur anywhere small intestine or colon BUT most commonly sigmoid colon
Asian heritage develop Right colon
Exception
Multiple diverticula without inflammation or symptoms
Diverticulosis
Diverticulosis
Multiple diverticula without inflammation or symptoms
Predisposing factors
decreased intake of dietary fiber
when food and bacteria retained in the diverticulum produce infection and inflammation
Diverticulitis
Diverticulitis
when food and bacteria retained in the diverticulum produce infection and inflammation
Symptoms
Abscess, fistula formation, obstruction, perforation, peritonitis and hemorrhage
Abscess, fistula formation, obstruction, perforation, peritonitis and hemorrhage
Symptoms
developed countries; increases with age
lead to perforation or abscess
If occurs at less than 50 years of age – may be related to obesity
random
acute onset of mild to severe pain in left lower quadrant with nausea, vomiting, chills and leukocytosis
With diverticulitis
With diverticulitis
acute onset of mild to severe pain in left lower quadrant with nausea, vomiting, chills and leukocytosis
t/f diverticular is proceeded by chronic constipation
true
If left untreated
can result in peritonitis and septicemia
can result in peritonitis and septicemia
If left untreated
Generally mild
Bowel irregularity – intervals of diarrhea, nausea, anorexia, bloating, abdominal distention
If bowel is repeatedly inflamed, results in narrowing in bowel, cramps, narrow stools, increased constipation and increased risk for obstruction
Weakness, fatigue and anorexia
Signs and Symptoms:
Signs and Symptoms:
Generally mild
Bowel irregularity – intervals of diarrhea, nausea, anorexia, bloating, abdominal distention
If bowel is repeatedly inflamed, results in narrowing in bowel, cramps, narrow stools, increased constipation and increased risk for obstruction
Weakness, fatigue and anorexia
Diverticulosis is diagnosed with…
colonoscopy
Diverticulitis is diagnosed with…
CT with contrast to reveal abscesses
Abdominal x-ray – reveals free air under the diaphragm if perforation is present
Labs: CBC – look at: increased WBC (infection), Increased ESR (inflammation)
what is contraindicated acute diverticulitis
Colonscopy Contraindicated in acute diverticulitis because the risk of perforation in the presence of local infection may result in sepsis
will have tenderness, palpable mass, fever, leukocytosis
Abscess
Abscess
will have tenderness, palpable mass, fever, leukocytosis
abdominal pain localized over involved segment; often will follow with peritonitis
Perforation
Perforation
abdominal pain localized over involved segment; often will follow with peritonitis
abdominal pain, board-like abdomen, loss of bowel sounds, shock
Peritonitis
Peritonitis
abdominal pain, board-like abdomen, loss of bowel sounds, shock
abnormal passageway between body structures like bladder and bowel
Fistula
Fistula
abnormal passageway between body structures like bladder and bowel
due to inflamed diverticula eroding areas adjacent to arterial branches
Massive rectal bleeding
Massive rectal bleeding
due to inflamed diverticula eroding areas adjacent to arterial branches
Symptoms are less pronounced in an older adult
May not have abdominal pain until infections occurs
Overlook blood in the stool because they cannot see it due to visual changes, physical inability to inspect stools, or fear of knowing what blood is from
Gerontological Considerations:
Rest, analgesic meds, antispasmodic agents
Clear diet until inflammation subsides
High fiber, low fat diet: increases stool volume, decreases colonic transit time, increases intraluminal pressure
Antibiotics x 7-10 days
Bulk-forming laxative
NO seeds
Dietary and Pharmacologic Management:
Dietary and Pharmacologic Management:
Rest, analgesic meds, antispasmodic agents
Clear diet until inflammation subsides
High fiber, low fat diet: increases stool volume, decreases colonic transit time, increases intraluminal pressure
Antibiotics x 7-10 days
Bulk-forming laxative
NO seeds
For older adults, immunocompromised or taking corticosteroids
Acute diverticulitis:
Inpatient hospitalization: For
NPO, IV fluids, NG suctioning if vomiting or distention, put on bowel rest
Broad spectrum antibiotics x 7-10 days
Opioids or other analgesics for pain
Oral intake increased as: symptoms subside
Probiotics: to restore normal flora
Acute diverticulitis:
Propantheline bromide: antimuscarinic agent for cramps, stomach spasms and intestines
Oxyphencyclimine (Daricon) – antimuscarinic and anticholinergic
Acute diverticulitis:
Antispasmodic agents:
Acute diverticulitis:
Antispasmodic agents:
Propantheline bromide: antimuscarinic agent for cramps, stomach spasms and intestines
Oxyphencyclimine (Daricon) – antimuscarinic and anticholinergic
Needed immediately for: perforation, peritonitis, hemorrhage or obstruction
Use CT guided percutaneous drainage for abscess formation without peritonitis, hemorrhage or obstruction
IV Antibiotics
Surgical Management:
Surgical Management:
Needed immediately for: perforation, peritonitis, hemorrhage or obstruction
Use CT guided percutaneous drainage for abscess formation without peritonitis, hemorrhage or obstruction
IV Antibiotics
inflamed area is removed, then end to end anastomosis is completed
One stage resection surgery
inflamed area is removed, then end to end anastomosis is completed
One stage resection surgery
Multiple stage procedure surgery
More likely on diseased colon
Resection with anastomosis
Bowel is brought to abdominal wall and the distal end is closed over and left in the abdomen = colostomy
Re-anastomosed later if possible
