Diverticular Disease (Diverticulosis) and Diverticulitis

  1. Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.

Diverticular disease is characterized by the formation of tiny pouches or sacs (diverticula) in the colon lining, especially in the sigmoid colon. Diverticula typically form due to persistent constipation and low-fiber food, which raise colonic pressure (Elisei et al., 2019). The intense pressure leads to the creation of pouches by creating weak places in the colon wall. Diverticula are generally asymptomatic and are typically referred to as diverticulosis. Nonetheless, they can induce abdominal discomfort, bloating, and flatulence.

Diverticular Disease (Diverticulosis) and Diverticulitis

When the diverticula are inflamed, infected, and occasionally ruptured, diverticulitis develops. Food and feces stuck in the diverticula can lead to bacterial overgrowth and irritation, leading to inflammation and infection (Strate & Morris, 2019).

Diverticulitis signs and symptoms are stomach pain (particularly in the left lower quadrant), elevated body temperature, nausea, vomiting, and alterations in bowel patterns (Strate & Morris, 2019). Diverticulitis complications can result in perforation, peritonitis, and the development of abscesses.

Although the mechanisms by which diverticula form are identical in diverticulosis and diverticulitis, the two conditions manifest clinically in quite different ways. While diverticulosis seldom causes symptoms, diverticulitis can cause severe stomach pain and other complications. Perforation and peritonitis are two consequences of diverticulitis that can be fatal but are not seen in diverticulosis.

In contrast to diverticulitis, which may require antibiotics, intravenous fluids, and even surgery, diverticulosis treatment typically focuses on symptom management and complication mitigation, which includes dietary changes.

  1. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis

Pain in the LLQ, nausea, vomiting, low-grade fever, a positive stool for occult blood, a bloated abdomen with hyper-resonance to percussion, hypoactive bowel sounds, and tenderness to palpation are all consistent with a diagnosis of acute diverticulitis.

  1. List 3 risk factors for acute diverticulitis.

One of the risk factors for developing acute diverticulitis is age, as the prevalence of the disease rises with age. Those over 60 are statistically more likely to have this illness. One study found that by age 80, one in four people of both sexes suffers from severe diverticulitis (Strate & Morris, 2019).

Another risk factor is obesity, which increases a person’s likelihood of having the disease if they are overweight. According to the findings, obesity is indicated by a BMI of 30 or higher (Strate & Morris, 2019). Hence, the likelihood of acute diverticulitis increases proportionately to the BMI.

Cigarette smoking is associated with inflammation, which further damages already fragile tissues. Health problems are more common in those who consume more than ten cigarettes daily.

  1. Discuss why antibiotics and IV fluids are indicated in this case

Acute diverticulitis requires antibiotics and intravenous fluids due to the risk of life-threatening complications such as abscess formation, rupture, and peritonitis (Kupcinskas et al., 2020). A CT scan showed a bloated small bowel, which may indicate an abscess or rupture. Antibiotics are required to treat the illness and stop the spread of bacteria, which can cause consequences.

Intravenous fluids treat dehydration, stabilize electrolyte levels, and alleviate or prevent constipation (Kupcinskas et al., 2020). As stool gets stuck in the colon due to constipation, it feeds the bacteria that cause inflammation and infection, worsening diverticulitis symptoms. To assist in relieving symptoms and avoid complications, the individual may benefit from receiving intravenous fluids, electrolytes, and maybe laxatives.

References

  • Elisei, W., Brandimarte, G., & Tursi, A. (2019). Diverticulosis today. Minerva Gastroenterologica E Dietologica, 65(1). https://doi.org/10.23736/s1121-421x.18.02525-4
  • Järbrink-Sehgal, E., Rassam, L., Jasim, A., Walker, M., Talley, J., Agréus, L., Andreasson, A., & Schmidt, T. (2019). Diverticulosis, symptoms and colonic inflammation: A population-based colonoscopy study. American Journal of Gastroenterology, 114(3), 500–510. https://doi.org/10.14309/ajg.0000000000000113
  • Kupcinskas, J., Strate, L., Bassotti, G., Torti, G., & Tursi, A. (2020). Pathogenesis of diverticulosis and diverticular disease. Journal of Gastrointestinal and Liver Diseases, 28, 7–10. https://doi.org/10.15403/jgld-551
  • Strate, L., & Morris, M. (2019). Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology, 156(5), 1282-1298.e1. https://doi.org/10.1053/j.gastro.2018.12.033

Diverticular Disease (Diverticulosis) and Diverticulitis Assignment Instructions

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

  1. Compare and contrast the pathophysiology of diverticular disease (diverticulosis) and acute diverticulitis. (CO1)
  2. Identify risk factors for acute diverticulitis and the clinical signs and symptoms associated with the disease. (CO3)
  3. Explain the significance of physical exam and diagnostic findings in the diagnosis of diverticular disease. (CO4)

Due Date

Initial post is due on Wednesday by 11:59 p.m. MT. All posts are due by Sunday, 11:59 p.m. MT

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.

Total Points Possible: 100

Preparing the Assignment

Requirements:

Read the case study below.
In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario:

An 84- year-old -female who has a history of diverticular disease presents to the clinic with left lower quadrant (LLQ) pain of the abdomen that is accompanied by with constipation, nausea, vomiting and a low-grade fever (100.20 F) for 1 day.

On physical exam the patient appears unwell. She has signs of dehydration (pale mucosa, poor skin turgor with mild hypotension [90/60 mm Hg] and tachycardia [101 bpm]). The remainder of her exam is normal except for her abdomen where the NP notes a distended, round contour. Bowel sounds a faint and very hypoactive. She is tender to light palpation of the LLQ but without rebound tenderness. There is hyper-resonance of her abdomen to percussion.  

  • The following diagnostics reveal:  
  • Stool for occult blood is positive.
  • Flat plate abdominal x-ray demonstrates a bowel-gas pattern consistent with an ileus. 
  • Abdominal CT scan with contrast shows no evidence of a mass or abscess. Small bowel in distended. 

Based on the clinical presentation, physical exam and diagnostic findings, the patient is diagnosed with acute diverticulitis and she is admitted to the hospital. She is prescribed intravenous antibiotics and fluids (IVF). Her symptoms improved and she could tolerate a regular diet before she was discharged to home.   

Discussion Questions:

  1. Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.
  2. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.  
  3. List 3 risk factors for acute diverticulitis.
  4. Discuss why antibiotics and IV fluids are indicated in this case.