Diverticular

Disease Kerri-Ann Mchayle-Henry

Medica; Surgical Nursing 1 – Gastrointestinal System
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Diverticulosis is the presence of many abnormal
pouchlike herniations in the wall of the intestine.
Diverticulitis is the term used to describe an
inflammation of one or more of the diverticula.
Usually occurs in the sigmoid colon of the large
intestines
This is usually a symptom free disease unless bleeding
or inflammation occurs
 Muscle of the colon hypertrophies and becomes rigid
 mucosa and submucosa herniates through the colon
wall
 at weak points in the intestinal walls, herniation occur
 Muscles weaken as part of general aging or lack of
fiber
 w/o inflammation diverticula cause few problems
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If inflammation occurs b/c of trapped food or
bacteria then blockage of blood supply to the area
may occur

 Inflamed diverticulum leads to diverculitis and

peritonitis
Assessment
 On examination of the abdomen:
- Observe for distention
- Tenderness over the involved area
- Palpable colon
- Localized muscle spasm
- Guarded movement
- Rebound tenderness may be present
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Diverticular irritation
Disease 4
 Assessment cont’d
If generalized peritonitis is present:
-profound guarding occurs
- rebound tenderness is more widespread
- sepsis, hypotension, or hypovolemic shock can
occur

If the perforated diverticulum is close to the rectum,

a palpable mass may be felt during a rectal exam

Orthostatic changes may occur

If bleeding is massive, the patient may have

hypotension and dehydration that result in shock.
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When infection developes disease becomes
Diverticulitis, characterized by:
- elevated WBC
- decreased H&H (in the presence of Chronic or
severe bleeding)
- hematuria
- possible occult blood

Diagnostic Tests:
- X-ray with barium contrast (expt. acute drv-itis)
- Colonoscopy
- Flat film done to test for perforation
- CT Scan & Abdominal Ultrasonography to test
for abcess of bowel r/t drv-it is and to rule out
tumor in the large intestines
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Diverticular Disease
 Non-Surgical Management

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 Surgical
Management

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Bowel prep. w. enemas and laxatives daily for 1 to 2 days b4 surgery in no-acute stages;
A low-fiber diet several days →clear-liquid diet for the day or evening b4 surgery.
Due to risk of perforation aggressive bowel preparation is not required
bowel prep withheld for acute inflammation, persistent fever and abdominal pain

Operative:
Minimally Invasive Surgery(MIS) by Laparoscopy (↓ recov. time) or Tradtnl (↑recov. time)

Post: The patient may have a drain in place at the abdominal incision site for several
days. If a colostomy, the stoma may be covered with a petroleum gauze dressing bc the
colostomy does not drain for about 2 days or a colostomy bag may be placed over the
stoma. monitor for pinkish to cherry red color w/o retraction or prolapse into the
abdomen NPO w. NGT until peristalsis returns (about 2 to 3 days)Clear liquids are then
introduced slowly. Gradually, the diet is advanced to solid Patients who had laparoscopic
surgery do not usually have an NGT. Most patients with a colostomy for diverticulitis
have a sigmoid colostomy because the sigmoid colon is the most common site of
diverticulitis. Drainage from a sigmoid colostomy at first consists of loose stool, but
eventually the stool becomes formed. A tight seal around the stoma is essential to avoid
contact of feces with the skin. Give the patient an opportunity to express feelings about
the ostomy. reinforcing that anger and depression are normal responses. encourage the
patient to look at the stoma and touch the pouching system. teach the patient how to
self-manage ostomy care.

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 Chart 60-7
NURSING FOCUS ON THE OLDER ADULT: Diverticulitis

Provide antibiotics, analgesics, and anticholinergics as prescribed.

Observe older patients carefully for side effects of these drugs,
especially confusion (or increased confusion), urinary retention or
failure, and orthostatic hypotension.
• Do not give laxatives or enemas. Teach the patient and the
family about the importance of avoiding these measures.
• Encourage the patient to rest and to avoid activities that
may increase intra-abdominal pressure, such as straining and
bending.
• While diverticulitis is active, provide a low-fiber diet. When
the inflammation resolves, provide a high-fiber diet. Teach the
patient and family about these diets and when they are
appropriate.
• Because older patients do not always experience the
typical pain or fever expected, observe carefully for other signs of
active disease, such as a sudden change in mental status.
• Perform frequent abdominal assessments to determine
distention and tenderness on palpation.
• Check stools for occult or frank bleeding.
(Ignatavicius, Donna D.. Medical-Surgical Diverticular
03/03/10 Nursing: Patient-Centered
Disease Collaborative Care, Single 15
Volume, 6th Edition. W.B. Saunders Company, 022009. 64.3.4.1.1.2.2.1).
 Hospital stay for pt with divirticulitis is 2-4 days per complication

For pt with good response to meds, nutrition is next step

Assess pt’s resources to choose correct diet

Teach pt about incision care and temporary activity limitation

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Nurse-nurtritionist colloboration to encourage pt to:
- eat diet high in hemi- and cellulose fiber
- Wheat Bran; whole grain breads; cereals.
- eat at least 25-35g of fiber per day
- high fiber fresh fruits and vegetables to add bulk to stool
If pt is intolerant:
- drink lots of water to decrease bloating
- start diet gradually if high fiber was not common
- use bulk forming laxatives like metamucil to increase fecal size & consistency
- avoid alcohol b/c is cause bowel irritation
- avoid seeds and nuts b/c they could block diverticulum
- fat intake should not exceed 30% of daily caloric intake
- when there are symptoms of diverticulitis avoid all fiber
- provide oral and written instructions on insicion care

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