Diverticular Disease Andrea Nicholas Email this Author 9/26/2014 3:13:26 PM
Diverticular disease is a common gastrointestinal disorder. It affects
approximately 50% of people by the age of 50 and nearly 70% by the age of
80. In addition to age, risk factors include obesity, lack of physical
exercise, history of chronic constipation, smoking and NSAID use.
A diverticulum is a sac-like protrusion of mucosa occurring within the
intestinal wall. They can cause intermittent lower abdominal pain that is
tender to the touch (Peaston, 2012). Recent studies are challenging the
long held belief that age and dietary fiber are the major risk factors and
that patients with diverticulosis should avoid eating nuts, seeds and corn.
A study of 50,000 people followed for 18 years found that when these foods
were eaten the risk of diverticulitis decreased (Templeton & Strate, 2013).
There are other less understood etiologies such visceral hypersensitivity
in the absence of inflammation (Strate, Modi, Cohen & Spiegel, 2012).
Clincal presentation usually includes constant, severe lower abdominal pain
on the left side, tender to the touch and a change in bowel habits. Asians
usually report pain on the right side. The pain generally starts around the
navel then moves down to the lower abdomen. The pain can be exacerbated by
eating and reduced by large rectal bleeding. Other common symptoms can
include fever, tachycardia, anorexia, nausea and vomiting, and dysuria
(Peaston, 2012).
Differentials include rectal bleeding due to frequent constipation but not
associated with diverticula and relieved by laxatives, irritable bowel
syndrome which can be ruled out by a trial of IBS therapy, and appendicitis
which occurs mainly in younger patients and the pain is usually in the
right lower quadrant. Appendicitis can be ruled out by CT scan (Epocrates,
2014), (Peaston, 2012).
Diagnostics are generally dependent upon clinical presentation for
uncomplicated diverticular disease. However, a WBC, C-reactive protein or
Sed rate may help determine infection or inflammation. Polymorphonuclear
leukocytosis is present in acute diverticulitis. A CBC with differential
can determine is the patient is anemic due to rectal bleeding. A urinalysis
can rule out a UTI. A barium enema, colonoscopy, or CT scan of the abdomen
can confirm the presence of diverticula, mass abscess, streaky mesenteric
fat, or show gas in the bladder in cases of fistula. An x-ray can reveal
bowel dilation or ileus, obstruction, abscesses or air in the peritoneal
cavity. Other tests sometime used are cystoscopy, cystography, contrast
radiographs and sigmoidoscopy (Epocrates, 2014), (Peaston, 2012).
Treatment can include diet modifications, bulk-forming laxatives,
antispasmodics, antimuscarinics, antibacterials or hospitalization.
Percutaneous drainage is the most appropriate treatment for large
abscesses. Elective surgery should be recommended only to those who have
difficulty dealing with the chronic disease such as recurrent episodes, if
there is an inability to exclude carcinoma, if there is free perforation,
fistula, obstruction or stricture. There is a potential for poor functional
outcomes and persistent symptoms even after surgery which should be
considered. However, free perforation resulting in peritonitis requires
emergency surgery for a sigmoid colectomy (AHRQ, 2014).
For uncomplicated diverticular disease – Dietary modification includes
increasing fiber. Amoxicillin/clavulanate 500 mg po q 8 hrs x 7 days and
metronidazole 500 mg po q 8 hrs x 7-10 days is indicated for evidence or
suspicion of bacterial overgrowth. Tylenol may be administered for pain
(Epocrates, 2014).
Complications and need for referral include abscess, perforation,
strictures, obstruction, fistula, and neoplasm. Chronic diverticular
disease may contribute to emotional distress and a referral to a counselor
may be warranted.
Education includes review of and handout for a high fiber diet, importance
of increasing activity and drinking plenty of fluids. Keeping a food diary
can help patients recognize which foods exacerbate their symptoms. If a
barium enema was performed the stools may appear white for a few days.
After resolution of a first acute episode a colonoscopy should be performed
within 6 to 8 weeks to confirm or rule out the diagnosis (AHRQ, 2014)>
Use the order calculator below and get started! Contact our live support team for any assistance or inquiry.
[order_calculator]