Diverticulosis and Diverticulitis NCLEX Review

This NCLEX review will discuss diverticular disease: diverticulosis and diverticulitis.

As a nursing student, you must be familiar with diverticular disease and how to care for patients who are experiencing diverticulitis/diverticulosis.

These type of questions may be found on NCLEX and definitely on nursing lecture exams.

Don’t forget to take the Diverticulosis and Diverticulitis quiz.

You will learn the following from this NCLEX review:

• Definition of Diverticulosis and Diverticulitis
• Complications
• How it is diagnosed
• Treatment
• Nursing Interventions

Lecture of Diverticulosis and Diverticulitis

NCLEX Review for Diverticulosis and Diverticulitis

Diverticulosis and diverticulitis are two types of diverticular disease. DiverticulITIS is a complication of diverticulosis. Therefore, for a person to develop diverticulitis they must first have diverticulosis.

What is Diverticulosis? Diverticulosis is the formation of hollow sac cavities throughout the intestinal wall. These outpouching sacs can form anywhere throughout the intestine but are most commonly found in the sigmoid colon of the large intestine.

Main Points about Diverticulosis:

A person can have many of these outpouching areas which are called diverticula or a single one which is called diverticulum. Typically, when a patient has a single diverticulum they are at risk for developing more herniated sac areas.

Signs and Symptoms of Diverticulosis

Patients are usually asymptomatic until they develop a complication. If a patient does have signs and symptoms they may experience:

• change in bowel pattern (sudden constipation/diarrhea)
• abdominal bloating

*The patient may attribute these signs and symptoms to something else.

Many patients find out they have this disease at random. For example, they have a lower GI series performed for another reason and they find out they have multiple diverticula in the sigmoid colon OR the patient experiences a complication of diverticulosis (as noted below).

Complication of Diverticulosis

Diverticular Bleeding….why?

• Surrounding the diverticulum are arteries that supply the intestinal wall. Overtime, these walls thin and the arteries become very superficial within the diverticulum wall.  The artery wall can become weak overtime and eventually lose integrity which leads to GI bleeding or the diverticulum ruptures.  Many patients will experience painless bleeding and bright blood in the stool/rectum.

DiverticulITIS: inflammation of the diverticulum…hence the herniate sacs becomes inflamed (more is discussed below). This can lead to abscess, rupture of the diverticula which leads to peritonitis and sepsis.

Strictures/bowel obstruction: narrowing of the bowel wall that leads to bowel obstruction. This can be due to chronic episodes of diverticulitis or the presence of acute inflammation. Fecal matter or food can get stuck in this narrowing which causes obstruction.

Fistula: intestinal wall weakens so much that it creates an opening that acts as a channel or passage to other organs, such as another intestine or another organ. Most common type of fistula with diverticulitis/osis is colovesicular (fistula from intestine to bladder).

Causes of Diverticulosis

Not fully understood: It is possibly due to increased pressure in the colon due to constipation/straining during bowel movements which is most likely due to consuming a diet low in fiber.

• Low fiber diets don’t bulk the stool like high-fiber diets. Instead, the stools are smaller and drier. This requires the intestines to work harder to push the stool through the system and out the anus. Due to this, certain areas of the intestinal wall start to herniate overtime.
• Increases with age and tends to run in families

What causes Diverticulitis?

Again not fully understood:

• Not all people who have diverticulosis will develop diverticulitis
• Possibly due to stool getting stuck in the herniated pouches due to straining/constipation. Patients who consume low fiber diets have hard stools that stay in the colon longer. These stools are harder to push out which increases pressure in the intestine and this leads to the stool getting stuck in the out-pouching.
• Another possibility: The increased pressure in the colon causes a tear in the diverticulum which leads to infection and inflammation. This allows bacteria to migrate in the out-pouching and cause infection.

Complications of Diverticulitis

• Abscess: herniated pouch becomes full of infection and is swollen with pus. Patient will have major symptoms (fever, high WBC, intense abdominal pain, nausea, fever)
• Rupture of Diverticulum: sac tears open and spills it contents into the abdominal cavity. This leads to peritonitis.
• Obstruction due to the inflammation of the tissue or scarring of the tissue
• Fistula formation

Signs and Symptoms of Diverticulitis

Remember: “Pouch”

Pain in abdomen…mainly in the left lower quadrant

Observe abdominal bloating and blood in stool

Unrelenting cramping type pain

Constipation

High temperature

Diagnosed:

• Colonoscopy
• CT scan of the abdomen with contrast

Treatment:

• Most cases are treated with IV or oral antibiotics and bowel rest with slow introduction of foods as signs and symptoms decrease.
• Drainage of the abscess in the affected diverticulum
• For reoccur cases: Partial colectomy (bowel resection): remove diseased portion of the colon….if multiple surgeries are required where healthy bowel cannot be reconnected right away the patient may need a temporary colostomy until it heals and then it will be reconnected.

Nursing Interventions for Diverticulitis

Monitor GI system and diet status closely:

During initial phase of moderate to severe diverticulitis…physician may prescribe IV antibiotics (oral if case is mild) to kill the infection and diet will be NPO…bowel rest so healing can begin.

• MD may order TPN/IV fluids or fat emulsions to help with nutrition
• Nurses role: administering medications, monitoring weights/hydration status, vital signs, signs of peritonitis…abdominal pain/tenderness, unrelenting fever, bloating, increased HR, RR), administering pain medication for abdominal pain

As signs and symptoms decrease:  advance patient’s diet per MD order to clear liquids and then low-fiber foods (NOTE: this is the only time a person with diverticulosis needs to consume a low-fiber diet)

• Clear liquids are anything that are clear that you can see through like Jello, broths, apple juice etc.
• Low-fiber foods: White rice, cooked fruits or vegetable without seeds or skin, eggs…Why no high-fiber foods yet? Bowel needs to rest and work very little…low-fiber foods allow this to happen.

Once recovered: needs to consume high fiber foods (fresh fruits and vegetables, beans, oats and other grains)…keeps stools soft and bulky…decreases episodes of constipation

• Drink plenty of fluids (2-3 L) to keep hydrated as tolerated (of course patients with heart failure and renal failure need to watch fluid intake per MD order)
• Goal to avoid constipation: MD may prescribe Psyllium (Metamucil)…mix in 8 oz water and have the patient drink it.
• Psyllium works by absorbing water from the intestine which in turns makes stool easier to pass (softer and bulker)
• Probiotics
• It was once thought that patients with diverticulosis should avoid seeds, nuts etc. but now research is showing patients do not have to avoid seeds (pumpkin, sunflower), nuts, fruit/veg with seeds unless they are intolerant to them already.

References