diverticulitis

diverticulitis is a topic covered in the Taber's Medical Dictionary.

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(dī″vĕr-tik″yŭ-līt′ĭs )

[diverticulum + -itis]
Inflammation of a diverticulum or diverticula in the intestinal tract, esp. in the colon, causing pain, anorexia, fevers, and, rarely, intestinal perforation, hemorrhage, abscess formation, peritonitis, fistula formation, or death.

INCIDENCE
Globally, most experts suggest that the incidence of the disease most likely parallels that in the U.S., which is 6% to 22% of the population depending on the population series. The lifetime recurrence is 30% after the first episode of diverticulitis and more than 50% after a second episode.

CAUSES
Patients generally have increased muscular contractions in the sigmoid colon that produce muscular thickness and increased intraluminal pressure. This increased pressure, accompanied by a weakness in the colon wall, causes diverticular formations. Diet may be a contributing factor. A diet with insufficient fiber reduces fecal residue, narrows the bowel lumen, and leads to higher intra-abdominal pressure during defecation. Diverticulitis is caused when stool and bacteria are retained in the diverticular outpouches, leading to the formation of a hardened mass called a fecalith. The fecalith obstructs blood supply to the diverticular area, leading to inflammation, edema of tissues, and possible bowel perforation and peritonitis.

RISK FACTORS
Diverticula can occur as a feature of several genetic disorders, including type IV Ehlers-Danlos syndrome and autosomal dominant polycystic kidney disease. Genetic contributions to isolated diverticula are suggested by the ethnic distribution. There is an increased incidence of right-sided diverticula among Asian populations and of left-sided disease among non-Asians.

SYMPTOMS AND SIGNS
Patients with diverticulitis usually report cramping in the left lower quadrant with abdominal pain that radiates to the back. Other complaints frequently reported are episodes of constipation and diarrhea, low-grade fever, chills, weakness, fatigue, abdominal distention, flatulence, and anorexia. Patients may report that symptoms often follow and are accentuated by the ingestion of foods such as popcorn, celery, fresh vegetables, whole grains, and nuts. Symptoms are also aggravated during stressful times.

DIAGNOSIS
Because diverticular disease is a chronic disorder that generally alters a patient’s nutritional intake, inspect for malnutrition symptoms such as weight loss, lethargy, brittle nails, and hair loss. Assess vital signs because temperature and pulse elevations are common. Palpate the patient’s abdominal area for pain or tenderness over the left lower quadrant. Palpate for a mass in this area, which may indicate diverticular inflammation.

TREATMENT
Depending on the severity, treatment may include antibiotics, pain relievers, and a change in diet, which starts off as a bland diet low in fiber or clear liquids until the pain disappears. For severe cases, hospitalization is required, and treatment includes giving antibiotics intravenously and administering IV fluids (nothing by mouth) to allow the bowel to rest. Other possible treatments include emptying the contents of the stomach (with a nasogastric tube), and, when necessary, surgery.

PATIENT CARE
During an acute episode, prescribed treatment with fluid and electrolyte replacement; antibiotics, antispasmodics, analgesics, and stool softeners; and nasogastric suction, if required, are initiated. The patient is observed for increasing or decreasing distress and for any adverse reactions to the therapy. Stools are inspected for mucus, blood, and consistency; the frequency of bowel movements is noted. The patient is assessed for fever, increasing abdominal pain, blood in the stools, and leukocytosis, and for indications of perforation, such as rebound tenderness. Rest is prescribed, and the patient is instructed not to lift, strain, bend, cough, or perform other actions that increase intra-abdominal pressure. When the patient resumes a normal diet, stool softeners may be employed.

Patients need to be educated about the disease and its symptoms. A well-balanced diet that provides dietary roughage from fruit, vegetable, and cereal fiber but that does not irritate the bowel is recommended, and fluid intake should be increased to 2 to 3 L daily (unless otherwise restricted). Constipation and straining at stool should be avoided, and the patient is advised to relieve constipation with stool softeners and bulk cathartics, taken with plenty of water. The importance of regular medical evaluation is emphasized. If medical treatment is not effective, a colon resection may be necessary to remove the affected area. Perforation, peritonitis, obstruction, or formation of fistulas may necessitate a temporary colostomy (so that abscesses may drain and the colon can rest), followed in 6 weeks to 3 months by reanastomosis.

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