Diverticular Disease PDF

Diverticular Disease Diets low in fiber that cause less bulky stool and constipation have been implicated in development of disease Sacs get invaded with bacteria from undigested food 2/3 of adults over 80 have it More men than women have it Diverticula: (diverticulum, sing.) ○ Pouch like herniation...

Diverticular Disease Diets low in fiber that cause less bulky stool and constipation have been implicated in development of disease Sacs get invaded with bacteria from undigested food 2/3 of adults over 80 have it More men than women have it Diverticula: (diverticulum, sing.) ○ Pouch like herniations of mucosa through the muscle wall of any part of the gut, usually the colon/ without inflammation few problems Diverticulosis: presence of these diverticula ○ What is it? A condition where small pouches are sacs called diverticula develop in the colon, typically in the lower part of the colon Extremely common in older adults ○ Causes Not known ○ Risk factors Diet Low-fiber diet Red meat Lack of exercise Obesity Smoking Medications → NSAIDS and steroids Genetics ○ Usually in sigmoid colon ○ Occur at points of weakness in intestinal wall ○ Muscle weakness develops because of aging or lack of fiber in the diet ○ If undigested food gets trapped in diverticulum, blood supply to area is reduced ○ Diverticulitis occurs which can cause local abscess ○ Local abscess can perforate and cause peritonitis ○ Signs and symptoms Usually no symptoms Often no symptoms and dx. on routine colonoscopy Diverticulitis: inflammation or infection of diverticula ○ What is it? Occurs when those diverticula (the pouches that form off the colon) become inflamed Itis → inflammation Many people with diverticulosis will never get diverticulitis ○ Signs and symptoms Abdominal pain, often in lower left quadrant/ can be intermittent but becomes steady Could be pain above pubic bone or on one side/ generalized if peritonitis occur Distended abdomen Nausea and vomiting Temp up to 101 degrees and may have chills Sometimes tachycardia May have rectal bleeding, if massive hypovolemia and hypotension If uncomplicated diverticulosis: no lab work necessary BUT with diverticulitis need WBC count (usually elevated), could have decreased hgb/hct Stool for occult blood Ct scan or ultrasound Colonoscopy 4-8 weeks after acute phase to r/o mass Secondary Prevention ○ Tests Colonoscopy: Definitive test Tertiary prevention ○ Antibiotics/analgesics ○ IV fluid if dehydrated ○ No laxatives/enemas because they increase intestinal motility ○ Rest: No straining or bending ○ Diet During attack: Low fiber diet When Ok: HIGH FIBER DIET Enjoy Whole grains → Whole wheat bread, brown rice, oats Fruits → Apples, pears, berries Vegetables → Broccoli, brussels sprouts, carrots Legumes → Beans, lentils, chickpeas Healthy fats →Avocado olive oil Avoid: Refined grains → White bread, white rice, white pasta Processed foods → Chips, cookies, sugary snacks Spicy foods → Hot peppers, chilli peppers, spicy sauces Dairy products (if intolerant) → Milk, cheese, ice cream, yogurt Alcohol Liquid diet for diverticulitis Water Popsicles Gelatin Tea and coffee (but they may irritate your digestive tract) Juice (no orange juice and no pulp) ○ ○ Broth (avoid any soups with solids) Aim for 25-35 g of fiber daily If patient cannot eat enough dietary fiber, take supplement Ex: Benefiber Drink plenty of fluids, especially water Eliminate: nuts, corn, popcorn, cucumbers, tomatoes and figs Dietary fat should not exceed 30% of caloric intake Check Stools for blood check b/p check for abdominal distention If uncontrolled bleeding or very acute case could do colon resection