DIVERTICULAR DISEASE AND

INTESTINAL OBSTRUCTION
PRESENTED BY GROUP 2 (NR-32)
 INTRODUCTION
DIVERTICULUM
 is a saclike herniation of the lining of
the bowel that extends through a defect
in the muscle layer.
 Diverticula- may occur anywhere in
the small intestine or colon but most
commonly in the sigmoid colon (atleast
95%) (Beitz, 2004
 However, persons of Asian heritage
tend to develop diverticula in the right
colon, probably because of genetic
differences.
DIVERTICULOSIS DIVERTICULITIS
 Occurs during presence of
multiple diverticula without
inflammation or symptoms
 Very common in developed
 Infection due to retained food or
countries; more than 50% of
Americans older than 80 years bacteria in diverticulum which
have diverticulosis (Beitz, 2004)
impedes drainage and perforation
 Most cases are asymptomatic, or abscess formation (Smelzer, S.,
exact prevalence cause is
et al, (2010).
unknown
ANATOMY OF DIGESTIVE SYSTEM
 DIGESTIVE
SYSTEM
Organ tubular system which breaks down and absorbs food. It
also pivotal for homeostasis or cells survival through hydrolysis
and it includes mouth, salivary glands, pharynx (throat),
esophagus (Food tube), stomach, small and large intestine, liver,
gallbladder snd pancreas.

ETYMOLOGY
“DIS” ; APART, “-GERERE” ; TO CARRY
 THE STOMACH

Responsible for digestion of food from esophagus which mizes

its content and contracts to propel food into smaller intestines
by breaking down and absorption,
 LARGE
INTESTINES
Responsible for digestion of food from esophagus which mizes
its content and contracts to propel food into smaller intestines
by breaking down and absorption,

5 FT. LONG, 3 IN. DIAMETER

 SMALL
INTESTINES
The small intestine absorbs 90 per cent of your body's nutrients.
the section of the digestive tract that is the longest. Food is kept
in your small intestine for up to four hours after you eat it.

10 FT LONG, 1 IN. DIAMETER

PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
PHYSICAL ASSESSMENTS, DIAGNOSTIC AND LABORATORY
PROCEDURE

• Physical Examination such as Manual muscle testing

and palpation to feel for tenderness or masses and left-
sided abdominal pain.

• Blood test. Doctors may use blood tests to check for

signs of diverticular disease and its complications.

• A stool sample. This test checks for any abnormal

bacteria or parasites in your digestive tract. To do this, a
small stool sample is taken and sent to a lab. It can also
check for blood in the stool.
PHYSICAL ASSESSMENTS, DIAGNOSTIC AND LABORATORY
PROCEDURE

Imaging tests
Doctors/nurses typically diagnose diverticular disease with
imaging tests, such as:

• X-rays. A small amount of radiation is used to make

images of body tissues onto film.

• Abdominal/Pelvis CT scan. This test shows detailed

images of any part of the body, such as the bones, muscles,
fat, and organs. This is used to check for complications of
diverticular disease like diverticulitis.
PHYSICAL ASSESSMENTS, DIAGNOSTIC AND LABORATORY
PROCEDURE

• Colonoscopy. This test looks at the full length of your

large intestine. It can help check for any abnormal
growths, tissue that is red or swollen, sores (ulcers), or
bleeding. A long, flexible, lighted tube with a camera on
the end (colonoscope) is put into your rectum up into the
colon.
 SURGICAL MANAGEMENT
 Primary Bowel Resection
The surgeon removes diseased segments of your
intestine and then reconnects the healthy segments
(anastomosis). This allows you to have normal bowel
movements.
 Bowel Resection with colostomy
 If you have so much inflammation that it is not
possible to rejoin your colon and rectum, the surgeon
will perform a colostomy. An opening (stoma) in your
abdominal wall is connected to the healthy part of
your colon. Waste passes through the opening into a
bag. Once the inflammation has eased, the colostomy
may be reversed and the bowel reconnected.
MEDICAL MANAGEMENT
ANTIBIOTICS

Oral antibiotic, such as metronidazole (Flagyl®), trimethoprim-sulfamethoxazole (Bactrim®), ciprofloxacin (Cipro®) or

amoxicillin and clavulanic acid (Augmentin®).
Rest, taking over-the-counter medications for pain and following a low-fiber diet or a liquid diet may be recommended until
your symptoms improve.
MEDICAL MANAGEMENT
WARNINGS
ANTIBIOTICS

The use of antibiotics can sometimes be avoided in uncomplicated diverticulitis – but only if an ultrasound or CT scan has
been done and no abscesses were found. Then antibiotics probably wouldn’t reduce the risk of complications. In one large
study, about 1 out of 100 participants had an abscess or an intestinal perforation – regardless of whether or not they had taken
antibiotics. In rare cases, though, these scans may fail to discover abscesses or perforations.
Antibiotics are generally only recommended for the treatment of uncomplicated diverticulitis if there’s an increased risk of
complications – for instance if someone has chronic kidney disease, a weakened immune system, high blood pressure or
allergies. Due to a lack of studies on treatment with antibiotics in high-risk patients, it’s not yet possible to say how effective
antibiotics really are in those cases.

REFERENCE

https://www.radiologyinfo.org/en/info/diverticulitis

https://www.ncbi.nlm.nih.gov/books/NBK506996/
NURSING MANAGEMENT

 fluid intake of 2 L/day and

suggests foods that are soft but have
increased fiber, such as prepared
cereals or soft-cooked vegetables

 An individualized exercise program is

encouraged to improve abdominal
muscle tone
NURSING CARE PLAN
DIVERTICULAR DISEASE AND
INTESTINAL OBSTRUCTION
PRESENTED BY GROUP 2 (NR-32)
INTESTINAL OBSTRUCTION

• A partial or complete block of the small or large intestine that keeps food,
liquid, gas, and stool from moving through the intestine in a normal way.
• A bowel obstruction can either be a mechanical or functional obstruction of
the small or large intestines. The obstruction occurs when the lumen of the
bowel becomes either partially or completely blocked. Obstruction frequently
causes abdominal pain, nausea, vomiting, constipation-to-obstipation, and
distention.
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS

Symptoms of intestinal obstruction may include the following:

•• Abdominal cramps and pain

•• Bloating
•• Vomiting
•• Nausea
•• Dehydration
•• Malaise (an overall feeling of illness)
•• Lack of appetite
•• Severe constipation.
PHYSICAL ASSESSMENT, DIAGNOSTIC AND LABORATORY
PROCEDURE
• Physical exam – It may suspect intestinal
obstruction if your abdomen is swollen or
tender or if there's a lump in your abdomen and
guarding (ischemia/perforation).
PHYSICAL ASSESSMENT, DIAGNOSTIC AND LABORATORY
PROCEDURE

LABORATORY EXAMINATIONS

- CBC
- Electrolyte imbalances (Hypolakemia)
 PHYSICAL ASSESSMENT, DIAGNOSTIC AND LABORATORY
PROCEDURE

X-ray Computerized Ultrasound Air or barium enema.

To confirm a diagnosis tomography (CT)
of intestinal obstruction, A CT scan combines a
It is recommended to series of X-ray images
undergo abdominal X- taken from different angles
ray. However, some to produce cross-sectional
intestinal obstructions images. These images are
can't be seen using more detailed than a
standard X-rays. standard X-ray, and are
more likely to show an
intestinal obstruction.
When an intestinal
obstruction occurs in
children, ultrasound is often
the preferred type of
imaging. In youngsters with
an intussusception, an
ultrasound will typically
show a "bull's-eye,"
representing the intestine
coiled within the intestine.
An air or barium enema allows
for enhanced imaging of the
colon. This may be done for
certain suspected causes of
obstruction. During the
procedure, the doctor will
insert air or liquid barium into
the colon through the rectum.
For intussusception in children,
an air or barium enema can
actually fix the problem most
of the time, and no further
treatment is needed.
 NURSING MANAGEMENT
 The patient with a small bowel  Abdominal radiography is an effective
obstruction who Does not require initial examination in patients with
surgery include: suspected intestinal obstruction.
• maintaining the function of the NG  Clinically stable patients can be
tube, assessing and measuring the treated conservatively with bowel rest,
NG output, assessing for fluid and intubation and decompression, and
electrolyte imbalance, monitoring intravenous fluid resuscitation.
nutritional status, and assessing for  Surgery is warranted in patients with
manifestations consistent with intestinal obstruction that does not
resolution resolve within 48 hours after
conservative therapy is initiated.
NURSING CARE PLAN