DIVERTICULAR DISEASE

INTRODUCTION
Diverticular disease (diverticulosis, diverticulitis) is a general term that refers to the
presence of diverticula, small pouches in the large intestinal (colonic) wall. These
outpouchings arise when the inner layers of the colon push through weaknesses in the
outer muscular layers. [1] Notably, diverticulosis can occur anywhere in the colon, but it
is most common in the left colon (descending or sigmoid colon).
CAUSES AND RISK FACTORS
Diverticular disease develops when pouches form along your digestive tract, typically in
your colon (large intestine). These pouches (diverticula) can become inflamed and
infected, which may occur when feces or partially digested food blocks the opening of
the diverticula. Although there’s no single known cause of diverticular disease, several
factors can increase the risk of developing diverticulitis, including:
• Genetics
• Diet
• Decreased immune function
• Having obesity
• Physical inactivity
• Smoking
• Changes in the gut microbiome
• Certain medications, such as steroids
PATHOPHYSIOLOGY
DIAGNOSIS
Tests can include:
• Abdominal ultrasound, abdominal MRI scan, abdominal CT scan, or abdominal
Xray to create pictures of your gastrointestinal (GI) tract
• Colonoscopy to examine the inside of your GI tract; although this takes place
after a bout of diverticulosis
• Stool test to check for infections, such as Clostridium difficile (C. diff)
• Urine test to check for infections
• Blood tests to check for signs of inflammation, anemia, or kidney or liver
problems
• Pelvic exam to rule out gynecological problems in people assigned female at birth
• Pregnancy test to rule out pregnancy in people assigned female at birth
MEDICAL MANAGEMENT
The treatment that your doctor prescribes for diverticulitis will depend on how severe
your condition is.
Uncomplicated diverticulitis can typically be treated at home. Your doctor might
encourage you to make changes to your diet. In some cases, they might prescribe
medications, including antibiotics.
Medication
To reduce pain or discomfort from diverticulitis, your doctor might recommend over-
thecounter pain medications, such as acetaminophen (Tylenol).

If they suspect you have an infection, they’ll likely prescribe antibiotics to treat it. These
can include:
• Metronidazole (Flagyl, Flagyl ER)
• Amoxicillin
• Moxifloxacin
If you develop a complicated case of diverticulitis that can’t be treated through diet and
medication alone, your doctor might recommend one of the following procedures:
• Needle drainage. In this procedure, a needle is inserted into your abdomen to
drain an abscess of pus.
• Surgery. Surgeries may involve draining an abscess of pus, repairing a fistula, or
removing infected segments of the colon.
NURSING INTERVENTIONS

(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.
COMPLICATIONS

• Abscess, an infected pocket that’s filled with pus

• Phlegmon, an infected area that’s less well-confined than an abscess
• Fistula, an abnormal connection that can develop between two organs or
between an organ and the skin
• Intestinal perforation, a tear or hole in the intestinal wall that can allow the
contents of your colon to leak into your abdominal cavity, causing inflammation
and infection
• Intestinal obstruction, a blockage in your intestine that can stop stool from
passing