Diverticulitis is an inflammation of diverticula, small pouches that can form in the lining of the intestines. It is most often caused by a low-fiber diet which requires the intestines to work harder to push stool through. Common symptoms include abdominal pain, fever, bloating and changes in bowel habits. Diagnosis involves blood tests and imaging scans. Treatment focuses on antibiotics to treat infection as well as pain medications. Surgery may be needed for complications like abscesses or perforations. Nursing care involves administering medications, maintaining bed rest, and monitoring for worsening symptoms.

1. THE TICKING BOMB IN THE
ABDOMEN
DIVERTICULITIS
DIVERTICULOSIS

2. DEFINITIONS
• DIVERTICULUM – SAC-LIKE PROTRUSION OF THE GUT WALL
• DIVERTICULA – MEANS MORE THAN ONE DIVERTICULUM
• DIVERTICULOSIS – DESCRIBES THE PRESENCE OF DIVERTICULUM. MAY
BE SYMPTOMATIC OR ASYMPTOMATIC
• DIVERTICULITIS – INFLAMMATION OF THE DIVERTICULUM. ACUTE OR
CHRONIC
• COMPLICATED DIVERTICULITIS – WITH ONE OF THE FF: BOWEL
OBSTRUCTION, ABSCESS, FISTULA OR PERFORATION
• UNCOMPLICATED DIVERTICULITIS – WITHOUT ASSOCIATED SYMPTOM

3. DIVERTICULOSIS
PRESENCE OF DIVERTICULUM

4. DIVERTICULOSIS

5. ETIOLOGY AND RISK FACTORS
• LOW FIBER DIET
• ADVANCED AGE (MORE THAN HALF OF PEOPLE OVER AGE 70 HAVE
THAT CONDITION)
THE FOLLOWING MAY CONTRIBUTE AS WELL
• HIGH FAT INTAKE
• LACK OF REGULAR ACTIVITY

6. ANATOMY/PHYSIOLOGY

7. PATHOPHYSIOLOGY
• DIVERTICULI DEVELOPS IN THE WEAK REGIONS OF THE COLON.
• WHEN CIRCULAR MUSCLE CONTRACTIONS OCCUR IN PATIENTS WITH SMALL AMOUNTS OF STOOL
IN THE COLON, THE COLON LUMEN BECOMES OCCLUDED.
• WHEN TWO CONTRACTIONS OCCUR CLOSE TO ONE ANOTHER , THE LUMEN OF THE INTERVENING
SEGMENT OF THE COLON IS ISOLATED FROM THE REST OF THE COLON AND HIGH PRESSURE IS
GENERATED IN THAT SEGMENT.
• INCREASED PRESSURE RESULTS IN THE FORMATION OF DIVERTICULA BY PLACING INCREASED
TENSION ON THE COLON WALL.

8. SIGNS AND SYMPTOMS
• NON-SPECIFIC ABDOMINAL PAIN CONSTANT OR RELIEVED BY FLATULATION OR DEFECATION
• BLOATING AND CHANGE IN BOWEL HABITS
• PAINLESS HEMATOCHEZIA
• SYNCOPE, LIGHTHEADEDNESS, POSTURAL DIZZINESS
• WITH SEVERE BLEEDING
• CHRONIC DIARRHEA

9. DIAGNOSTICS
• HGB: NORMAL (<24H) OR LOW (>24H)
• RBC: NORMOCYTIC (ACUTE BLEED) OR MICROCYTIC (CHRONIC BLEED)
• BUN: SCR: NORMAL (VS. UPPER GI BLEED)
• COLONOSCOPY
• RADIOGRAPHOLOGY
• ENDOSCOPY: INFLAMMATION OF INTERDIVERTICULAR MUCOSA, REDDISH LESIONS, ULCERS, EDEMA,
DIFFUSE EROSIONS
• HISTOLOGY: CHRONIC INFLAMMATORY CHANGES (INFLAMMATORY INFILTRATION, GLANDULAR
ARCHITECTURE CHANGES, CRYPT ABSCESSES, CRYPT HEMORRHAGE)

10. PHARMACOLOGIC INTERVENTION
• BROAD SPECTRUM ANTIBIOTICS IF ASYMPTOMATIC

11. SURGICAL INTERVENTION
• COLOSTOMY
• ILIOSTOMY
• RIGHT OR LEFT HEMICOLECTOMY
• SUBTOTAL COLECTOMY WITH ANASTAMOSIS

12. DIVERTICULITIS
INFLAMMATION OF THE DIVERTICULUM

13. DEFINITION
• INFLAMMATION OF ONE OR MORE DIVERTICULA, WHICH ARE SMALL
POUCHES CREATED BY HERNIATION OF MUCOSA INTO THE WALL OF
THE COLON.
• CONSIDERED A DISEASE OF THE ELDERLY, BUT AS MANY AS 20% OF
PATIENTS WITH DIVERTICULITIS ARE YOUNGER THAN 50 YEARS.

14. FISTULIZATION
• A COMPLICATION OF DIVERTICULITIS
• FISTULAS TO ADJACENT ORGANS AND SKIN MAY DEVELOP, ESPECIALLY IN
THE PRESENCE OF AN ABSCESS.
• COLOVESICULAR FISTULAS MOST COMMON IN MEN
• IN WOMEN, THE UTERUS IS INTERPOSED BETWEEN THE COLON AND THE
BLADDER, AND THIS COMPLICATION IS ONLY SEEN FOLLOWING A
HYSTERECTOMY. THE UTERUS PRECLUDES FISTULA FORMATION FROM THE
SIGMOID COLON TO THE URINARY BLADDER. HOWEVER, COLOVAGINAL
AND COLOCUTANEOUS FISTULAS CAN FORM BUT ARE UNCOMMON.

15. ETIOLOGY
• HAPPENS WHEN POUCHES FORM IN THE WALL OF THE COLON.
• IF THESE POUCHES GET INFLAMED OR INFECTED, IT IS CALLED DIVERTICULITIS.
• DOCTORS AREN’T SURE WHAT CAUSES DIVERTICULOSIS, BUT THEY THINK A LOW-FIBER DIET MAY
PLAY A ROLE. WITHOUT FIBER TO ADD BULK TO THE STOOL, THE COLON HAS TO WORK HARDER
THAN NORMAL TO PUSH THE STOOL FORWARD. THE PRESSURE FORM THIS MAY CAUSE POUCHES
TO FORM IN WEAK SPOTS ALONG THE COLON.
• BACTERIA CAN GROW IN THE POUCHES, AND LEAD TO INFLAMMATION AND INFECTION.

16. RISK FACTORS
• “DISEASE OF THE WESTERN CIVILIZATION”
• LOW FIBER CONSTIPATION
• OBESITY, LACK OF PHYSICAL ACTIVITY
• NSAIDS
• SMOKING

17. ANATOMY/PHYSIOLOGY
• PSEUDODIVERTICULA –
HERNIATIONS OF MUCOSA AND
SUBMUCOSA BY SEROSA WHERE
VASA RECTAE PENETRATE THE
CIRCULAR MUSCULAR LAYER
• BETWEEN EACH SIDE OF THE
MESENTERIC TAENIA , AND ON ONEA
SIDE OF THE ANTIMESENTERIC
TAENIAE

18. PATHOPHYSIOLOGY
• MICRO OR MACROSCOPIC PERFORATION OF THE
DIVERTICULUM SUBCLINICAL INFLAMMATION DUE TO
GENERALIZED PERITONITIS
• PREVIOUSLY THOUGHT TO BE DUE TO FECALITHS
CAUSING INCREASED DIVERTICULAR PRESSURE (RARE)
• EROSION OF DIVERTICULAR WALL FROM INCREASED
INTRAUMINAL PRESSURE INFLAMMATION FOCAL
NECROSIS PERFORATION
• USUALLY INFLAMMATION IS MILD AND
MICROPERFORATIOIS WALLED OFF BY PERICOLONIC FAT
AND MESENTERY

19. SIGNS AND SYMPTOMS
• MOST COMMON SYMPTOM: BELLY PAIN, USUALLY IN THE LOWER LEFT SIDE THAT
IS SOMETIMES WORSE WHEN YOU MOVE
• FEVER AND CHILLS
• BLOATING AND GAS
• DIARRHEA OR CONSTIPATION
• NAUSEA AND SOMETIMES VOMITING
• NOT FEELING LIKE EATING

20. DIAGNOSTIC
• CBC: (OFTEN SEE LEUKOCYTOSIS)
• ELECTROLYTES
• R/O UA
• R/O PREGNANCY TEST (WOMEN)
• SERUM AMINOTRANSFERASES
• ALKALINE PHOSPHATE
• BILIRUBIN
• AMYLASE
• LIPASE
• CULTURES: ONLY TO PATIENTS WITH DIARRHEA
• R,O INFECTIOUS PROCESS
• CT SCAN
• ULTRASOUND

21. PHARMACOLOGIC INTERVENTION
• ANTIBIOTICS TO TREAT INFECTION (MONOTHERAPY: PIPERACILLIN/TAZOBACTAM,
AMPICILLIN, SULBACTAM, TICARCILLIN/CLAVULANIC ACID, IMIPENEM/MEROPENEM)
(MULTIPLE DRUG REGIMENS: METRONIDAZOLE WITH CEPHALOSPORIN,
CEFOTAXIME, CEFTOLOZANETAZOBACTAM, CIPROFLOXACIN
• MORPHINE : ACCEPTABLE FOR PAIN CONTROL
• OVER-THE-COUNTER PAIN RELIEVER SUCH AS ACETAMINOPHEN (TYLENOL) (HAS
BEEN ASSOCIATED WITH A GREATER RISK FOR COLON PERFORATION AND SHOULD
BE AVOIDED WHENEVER POSSIBLE
• INTRAVENOUS ANTIBIOTICS (FOR COMPLICATED DIVERTICULITIS

22. MEDICAL INTERVENTION
• INSERTION OF A TUBE TO DRAIN AN ABSCESS, IF ONE HAS FORMED

23. SURGICAL INTERVENTION
NEEDED IF YOU HAVE A COMPLICATION SUCH AS PERFORATION, ABSCESS, FISTULA, OR BOWEL
OBSTRUCTION
 PRIMARY BOWEL RESECTION – THE SURGEON REMOVES THE DISEASED SEGMENTS OF YOUR
INTESTINE AND THEN RECONNECTS THE HEALTHY SEGMENTS (ANASTOMOSIS) THIS ALLOWS YOU
TO HAVE NORMAL BOWEL MOVEMENTS. DEPENDING ON THE AMOUNT OF INFLAMMATION, YOU
MAY HAVE OPEN SURGERY OR A MINIMALLY INVASIVE (LAPAROSCOPIC) PROCEDURE.
 BOWEL RESECTION WITH COLOSTOMY: IF THERE IS SO MUCH INFLAMMATION IT IS NOT POSSIBLE
TO REJOIN THE COLON AND RECTUM, A COLOSTOMY WILL BE PERFORMED.

24. NURSING CONSIDERATIONS
• ADMINISTER ANTIBIOTICS, STOOL SOFTENERS, AND ANTI-SPASMODICS
• MAINTAIN BED REST (ACUTE DIVERTICULITIS)
• MAINTAIN LIQUID DIET DURING THE ACUTE ATTACK
• WHEN ADMINISTERING MEDICATIONS, MONITOR FOR SIGNS. WATCH FOR TEMPERATURE
ELEVATION, INCREASING ABDOMINAL PAIN, BLOOD IN STOOLS AND LEUKOCYTOSIS.
• IF PATIENT HAS HAD ANGIOGRAPHY, INSPECT INSERTION SITE FOR BLEEDING.