diverticulitis

diverticulitis

1. pathophysiology

   • Inflammation of one or more diverticula (outpouchings of the colon).  Diverticula can occur anywhere in the GI tract but are most common in the left (descending, sigmoid) colon.  Occur more at weak points in the intestinal wall, such as where the blood vessels pass through the muscle layer.

2. clinical manifestations

   • Majority of patients have no symptoms but symptoms can usually be abdominal pain, bloating, flatulence, decrease of appetite, and changes in bowel habits.  Most common symptoms are acute pain in the left lower quadrant, a palpable abdominal mass, nausea, vomiting, and systemic symptoms of infection such as a fever, increased CRP and increase in WBC.  
   • contributing factors
     • Age - Older patients more at risk.  Smokers, sedentary lifestyle - lack of exercise, obesity, diet that is low in fiber and high in animal fat, certain medications such as steroids, opiates and NSAIDS 
     • nursing interventions
       • assess level of pain, assess 30 mins before and after pain meds and administer pain meds.  Observe for number of BM's, consistency and for blood.  Nonpharmacologic measures to assist with pain control.  Assess vital signs/temp.  Report any abnormal findings to the HCP.  Assess mental status and LOC.  Report and note any abnormal lab values to the HCP.  
   • complications
     • fistula formation, perforation, stricture formation and abscess.  
   • treatment
     • antibiotics, comfort measures with pain medications, bed rest, bowel rest (1-2 days of liquid diet) and increase of fiber in diet.  

3. diagnostic studies

   • When there are no symptoms diverticulitis is typically diagnosed during a routine sigmoidoscopy or colonoscopy.  Diagnosis is based on history and physical.  Preferred diagnostic test is a CT scan with oral contrast.  Abdominal and chest x-ray can rule out other causes of the abdominal pain.  Testing of stool for occult blood.  CBC, UA, blood cultures and barium enema.  

4. potential nursing diagnosis

   • Risk for infection.  Acute pain related to inflammed bowel as evidence by pt rates pain 8/10 on the pain scale, abd cramping/pain and tenderness.