Diverticular Disease - NurseCe4Less.com · 28/12/2015 · Diverticulosis and diverticular disease are common in Western and industrialized countries — particularly the United States,

1

nursece4less.comnursece4less.comnursece4less.comnursece4less.comnursece4less.comnursece4less.com

Diverticular

Disease

Elizabeth Boldon, RN, MSN

Elizabeth Boldon is a Nurse Education Specialist at Mayo Clinic in Rochester, Minnesota. She received a BSN from Allen College in Waterloo, Iowa in 2002 and an MSN with a focus in education from the University of Phoenix in 2008. She has bedside nursing experience in medical neurology and the neuroscience ICU.

Abstract

Diverticular disease is a common disease associated with significant potential

complications. Colonoscopy, X-rays and possibly computed tomography (CT)

assist in the diagnosis of diverticulosis and potential complications. Initial

therapy and treatment of complications, such as infection and bleeding,

related to diverticulosis are discussed, which includes endoscopic and

surgical interventions.

2


Policy Statement

This activity has been planned and implemented in accordance with the

policies of NurseCe4Less.com and the continuing nursing education

requirements of the American Nurses Credentialing Center's Commission on

Accreditation for registered nurses. It is the policy of NurseCe4Less.com to

ensure objectivity, transparency, and best practice in clinical education for

all continuing nursing education (CNE) activities.

Continuing Education Credit Designation

This educational activity is credited for 2 hours. Nurses may only claim credit

commensurate with the credit awarded for completion of this course activity.

Statement of Learning Need

Clinicians need to be able to recognize the symptoms of diverticular disease.

Patients with diverticular disease are at risk to develop infection and

bleeding. Current trends in the diagnosis and treatment of diverticular

disease are essential for the clinician to understand in order to appropriately

and safely manage the condition.

Course Purpose

To provide clinicians with knowledge to care for patients with diverticular

disease.

3


Target Audience

Advanced Practice Registered Nurses and Registered Nurses

(Interdisciplinary Health Team Members, including Vocational Nurses and

Medical Assistants may obtain a Certificate of Completion)

Course Author & Planning Team Conflict of Interest Disclosures

Elizabeth Boldon, RN, MSN, William S. Cook, PhD,

Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC

all have no disclosures

Acknowledgement of Commercial Support

There is no commercial support for this course.

Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article.

Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course.

4


1. Diverticulosis specifically describes a. the presence of diverticula with symptoms. b. the presence of diverticula. c. the presence of diverticula with diverticular bleeding. d. inflammation of a diverticulum.

2. Inflammation of a diverticulum, known as

___________________ occurs when there is thinning and breakdown of the diverticular wall. a. diverticulosis b. colitis c. diverticulitis d. diverticular bleeding

3. A fistula is

a. a localized collection of pus. b. an abnormal tract between two areas that are not normally

connected. c. a blockage of the colon. d. an infection around the abdominal organ.

4. Sepsis is defined as

a. an abnormal tract between two areas that are not normally

connected. b. an infection around the abdominal organ. c. a blockage of the colon. d. an overwhelming body-wide infection.

5. Diverticular bleeding occurs

a. when a small artery in a diverticulum erodes/bleeds into the colon. b. in 25% of cases of simple diverticulitis. c. in 75 percent of all cases of diverticulitis. d. All of the above.

5


Introduction

Diverticular disease of the colon is an important cause of hospital admissions

and a significant contributor to healthcare costs in the United States.

Diverticular disease consists of three conditions that involve the

development of small sacs or pockets in the wall of the colon (called

diverticulum) including diverticulosis, diverticular bleeding, and

diverticulitis.3 This course will describe all three of these conditions, as well

as their symptoms, causes, risk factors, diagnosis, complications and

treatment.

What Is Diverticular Disease?

Diverticular disease is defined as clinically significant and symptomatic

diverticulosis due to diverticular bleeding, diverticulitis, segmental colitis

associated with diverticula, or symptomatic uncomplicated diverticular

disease.

Diverticulosis

Diverticulosis merely describes the presence of diverticula. Diverticulosis is

often found during a test done for other reasons, such as flexible

sigmoidoscopy, colonoscopy, or barium enema. Most people with

diverticulosis have no symptoms and will remain symptom free for the rest

of their lives.3 A person with diverticulosis may have diverticulitis, or

diverticular bleeding.

6


Diverticulitis

Inflammation of a diverticulum (diverticulitis) occurs when there is thinning

and breakdown of the diverticular wall. This may be caused by increased

pressure within the colon or by hardened particles of stool, which can

become lodged within the diverticulum.

The symptoms of diverticulitis depend upon the degree of inflammation

present. The most common symptom is pain in the left lower abdomen.

Other symptoms can include nausea and vomiting, constipation, diarrhea,

and urinary symptoms such as pain or burning when urinating or the

frequent need to urinate.

Diverticulitis is divided into simple and complicated forms.

• Simple diverticulitis, which accounts for 75 percent of cases, is not

associated with complications and typically responds to medical

treatment without surgery.

• Complicated diverticulitis occurs in 25 percent of cases and usually

requires surgery. Complications associated with diverticulitis can

include the following:3

o Abscess – a localized collection of pus

o Fistula – an abnormal tract between two areas that are not

normally connected (i.e., bowel and bladder)

o Obstruction – a blockage of the colon

− Peritonitis – infection involving the space around the abdominal

organ

− Sepsis – overwhelming body-wide infection that can lead to

failure of multiple organs

7


Diverticular Bleeding

Diverticular bleeding occurs when a small artery located within a

diverticulum is eroded and bleeds into the colon. Diverticular bleeding

usually causes painless bleeding from the rectum. In approximately 50

percent of cases, the person will see maroon or bright red blood with bowel

movements.3,4

Symptoms Of Diverticular Disease

People with diverticulitis may have many symptoms, the most common of

which is pain in the lower left side of the abdomen. The pain is usually

severe and comes on suddenly, though it can also be mild and then worsen

over several days. The intensity of the pain can fluctuate. Diverticulitis may

also cause:

• fevers and chills

• nausea or vomiting

• a change in bowel habits — constipation or diarrhea

• diverticular bleeding

In most cases, people with diverticular bleeding suddenly have a large

amount of red or maroon-colored blood in their stool. Diverticular bleeding

may also cause:1

• weakness

• dizziness or light-headedness

• abdominal cramping

8


Causes Of Diverticular Disease

Diverticulosis is often found during tests performed for other reasons.4

• Barium Enema

This is an x-ray study that uses barium in an enema to view the

outline of the lower intestinal tract. This is an older test and has been

largely replaced by computed tomography (CT) scan.

• Flexible Sigmoidoscopy

This is an examination of the inside of the sigmoid colon with a thin,

flexible tube that contains a camera.

• Colonoscopy

This is an examination of the inside of the entire colon.

• CT Scan

A CT scan is often used to diagnose diverticulitis and its complications.

If diverticulitis (not just diverticulosis) is suspected, the above three

tests should not be used because of the risk of perforation.

Scientists are not certain what causes diverticulosis and diverticular disease.

For more than 50 years, the most widely accepted theory was that a low-

fiber diet led to diverticulosis and diverticular disease. Diverticulosis and

diverticular disease were first noticed in the United States in the early

1900s, around the time processed foods were introduced into the American

diet. Consumption of processed foods greatly reduced Americans’ fiber

intake.

9


Diverticulosis and diverticular disease are common in Western and

industrialized countries — particularly the United States, England, and

Australia — where low-fiber diets are common. The condition is rare in Asia

and Africa, where most people eat high-fiber diets. Two large studies also

indicate that a low-fiber diet may increase the chance of developing

diverticular disease. However, a recent study found that a low-fiber diet was

not associated with diverticulosis and that a high-fiber diet and more

frequent bowel movements may be linked to an increased rather than

decreased chance of diverticula.1

Other studies have focused on the role of decreased levels of the

neurotransmitter serotonin in causing decreased relaxation and increased

spasms of the colon muscle. However, more studies are needed in this area.

Studies have also found links between diverticular disease and obesity, lack

of exercise, smoking, and certain medications including nonsteroidal anti-

inflammatory drugs, such as aspirin, and steroids.

Scientists agree that with diverticulitis, inflammation may begin when

bacteria or stool get caught in a diverticulum. In the colon, inflammation

also may be caused by a decrease in healthy bacteria and an increase in

disease-causing bacteria. This change in the bacteria may permit chronic

inflammation to develop in the colon.1

Risk Factors For Diverticular Disease

Environmental and lifestyle factors are important risk factors for diverticular

disease.3,4

10


Diet

Fiber

The role of fiber in the development of diverticulosis is unclear. Several early

studies suggested that low dietary fiber predisposes to the development of

diverticular disease, but other studies have been conflicting. Fiber also does

not reduce symptoms in patients with symptomatic uncomplicated

diverticular disease. However, dietary fiber and a vegetarian diet may

reduce the incidence of symptomatic diverticular disease by decreasing

intestinal inflammation and altering the intestinal microbiota.

Fat and Red Meat

In one study, the risk of diverticular disease was significantly increased with

diets that were low in fiber and were high in total fat or red meat as

compared with diets that were low in both fiber and total fat or red meat.

Seeds and Nuts

Nut, corn, and popcorn consumption are not associated with an increase in

risk of diverticulosis, diverticulitis or diverticular bleeding. In addition, no

association has been found between consumption of corn and diverticulitis or

between nut, popcorn, or corn consumption and diverticular bleeding or

uncomplicated diverticulosis.

11


Physical Activity

It is unclear if lack of vigorous exercise is a risk factor for diverticular

disease. However, vigorous physical activity appears to reduce the risk of

diverticulitis and diverticular bleeding.

Obesity

Obesity has been associated with an increase in risk of both diverticulitis and


Other

Current smokers appear to be at increased risk for perforated diverticulitis

and a diverticular abscess as compared with nonsmokers. Caffeine and

alcohol are not associated with an increased risk for symptomatic diverticular

disease.

Several medications are associated with an increased risk of diverticulitis

and diverticular bleeding including nonsteroidal anti-inflammatory drugs,

steroids, and opiates. In contrast, statins may be associated with a

decreased risk of diverticular perforation. In addition, higher levels of

vitamin D have been associated with a reduced risk of hospitalization for

diverticulitis.

12


Diagnosis Of Diverticular Disease

Based on symptoms and severity of illness, a person may be evaluated and

diagnosed by a primary care physician, an emergency department physician,

a surgeon, or a gastroenterologist. The healthcare provider will ask about

the person’s health, symptoms, bowel habits, diet, and medications, and will

perform a physical exam, which may include a rectal exam. A rectal exam is

performed in the healthcare provider’s office. To perform the exam, the

healthcare provider asks the person to bend over a table or lie on one side

while holding the knees close to the chest. The healthcare provider slides a

gloved, lubricated finger into the rectum. The exam is used to check for

pain, bleeding, or a blockage in the intestine.

The healthcare provider may schedule one or more of the following tests

outlined below.

• Blood test:

A blood test involves drawing a person’s blood at a healthcare

provider’s office, a commercial facility, or a hospital and sending the

sample to a lab for analysis. The hemoglobin and complete blood count

(CBC) blood test can show the presence of inflammation or anemia —

a condition in which red blood cells are fewer or smaller than normal,

which prevents the body’s cells from getting enough oxygen.

• Computerized tomography (CT) scan:

A CT scan of the colon is the most common test used to diagnose

diverticular disease. CT scans use a combination of X-rays and

13


computer technology to create three-dimensional (3–D) images. For a

CT scan, the person may be given a solution to drink and an injection

of a special dye, called contrast medium. CT scans require the person

to lie on a table that slides into a tunnel-shaped device where the

X-rays are taken. The procedure is performed in an outpatient center

or a hospital by an X-ray technician, and a radiologist interprets the

images. Anesthesia is not needed. CT scans can detect diverticulosis

and confirm the diagnosis of diverticulitis.

• Lower gastrointestinal (GI) series:

A lower GI series is an x-ray exam that is used to look at the large

intestine. The test is performed at a hospital or an outpatient center by

an x-ray technician, and a radiologist interprets the images.

Anesthesia is not needed.

The healthcare provider may provide written bowel prep instructions to

follow at home before the test. The person may be asked to follow a

clear liquid diet for one to three days before the procedure. A laxative

or enema may be used before the test. A laxative is medication that

loosens stool and increases bowel movements. An enema involves

flushing water or laxative into the rectum using a special squirt bottle.

These medications cause diarrhea, so the person should stay close to a

bathroom during the bowel prep.

14


For the test, the person will lie on a table while the radiologist inserts a

flexible tube into the person’s anus. The colon is filled with barium,

making signs of diverticular disease show up more clearly on X-rays.

For several days, traces of barium in the large intestine can cause

stools to be white or light-colored. Enemas and repeated bowel

movements may cause anal soreness. A healthcare provider will

provide specific instructions about eating and drinking after the test.

• Colonoscopy:

This test is performed at a hospital or an outpatient center by a

gastroenterologist. Before the test, the person’s healthcare provider

will provide written bowel prep instructions to follow at home. The

person may need to follow a clear liquid diet for one to three days

before the test. The person may also need to take laxatives and

enemas the evening before the test.

In most cases, light anesthesia, and possibly pain medication, will help

a patient relax for the test. The patient lies on a table while the

gastroenterologist inserts a flexible tube into the anus. A small camera

on the tube sends a video image of the intestinal lining to a computer

screen. The test can show diverticulosis and diverticular disease.

Cramping or bloating may occur during the first hour after the test.

Driving is not permitted for 24 hours after the test to give the

15


anesthesia time to wear off. Before the appointment, a patient should

make plans for a ride home. Full recovery is expected by the next day,

and people should be able to go back to their normal diet.1

Complications Of Diverticular Disease

About 25 percent of people with acute diverticulitis develop complications,

which may include:2

• An abscess, which occurs when pus collects in the pouch

• A perforation, a small tear or hole in the diverticula

• A blockage in the colon or small intestine caused by scarring

• An abnormal passageway (fistula) between sections of bowel or the

bowel and bladder

• Peritonitis, a medical emergency that requires immediate care,

which can occur if the infected or inflamed pouch ruptures, spilling

intestinal contents into the abdominal cavity

Abscess, Perforation, and Peritonitis

Antibiotic treatment of diverticulitis usually prevents or treats an abscess. If

the abscess is large or does not clear up with antibiotics, it may need to be

drained. After giving the person numbing medication, a radiologist inserts a

needle through the skin to the abscess and then drains the fluid through a

catheter. An abdominal ultrasound or a CT scan usually is done prior to

deciding the procedure.

16


A person with a perforation usually needs surgery to repair the tear or hole.

Sometimes, a person needs surgery to remove a small part of the intestine if

the perforation cannot be repaired.

A person with peritonitis may be extremely ill, with nausea, vomiting, fever,

and severe abdominal tenderness. This condition requires immediate surgery

to clean the abdominal cavity and possibly a colon resection at a later date

after a course of antibiotics. A blood transfusion may be needed if the person

has lost a significant amount of blood. Without prompt treatment, peritonitis

can be fatal.1

Fistula

Diverticulitis-related infection may lead to one or more fistulas. Fistulas

usually form between the colon and the bladder, small intestine, or skin. The

most common type of fistula occurs between the colon and the bladder.

Fistulas can be corrected with a colon resection and removal of the fistula.

Intestinal Obstruction

Diverticulitis-related inflammation or scarring caused by past inflammation

may lead to intestinal obstruction. If the intestine is completely blocked,

emergency surgery is necessary, with possible colon resection. Partial

blockage is not an emergency, so the surgery or other procedures to correct

it can be scheduled.

17


When urgent surgery with colon resection is necessary for diverticulitis, two

procedures may be needed because it is not safe to rejoin the colon right

away. During the colon resection, the surgeon performs a temporary

colostomy, creating an opening, or stoma, in the abdomen. The end of the

colon is connected to the opening to allow normal eating while healing

occurs. Stool is collected in a pouch attached to the stoma on the abdominal

wall. In the second surgery, several months later, the surgeon rejoins the

ends of the colon and closes the stoma.1

Treatment Of Diverticular Disease

People with diverticulosis who do not have symptoms do not require

treatment. However, most clinicians recommend increasing fiber in the diet,

which can help to bulk the stools and possibly prevent the development of

new diverticula, diverticulitis, or diverticular bleeding. Fiber is not proven to

prevent these conditions in all patients but may help to control recurrent

episodes in some.3,4

Fiber

Increased fiber is recommended in the treatment of diverticular disease.

Fruits and vegetables are a good source of fiber.

Seeds and Nuts

Patients with diverticular disease have historically been advised to avoid

whole pieces of fiber (such as seeds, corn, and nuts) because of concern

that these foods could cause an episode of diverticulitis. However, this belief

18


is completely unproven. Current recommendations do not suggest that

patients with diverticulosis avoid seeds, corn, or nuts.

Medications

A number of studies suggest the medication mesalazine (Asacol), given

either continuously or in cycles, may be effective at reducing abdominal pain

and GI symptoms of diverticulosis. Research has also shown that combining

mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more

effective than using rifaximin alone to improve a person’s symptoms and

maintain periods of remission.1

Probiotics

Although more research is needed, probiotics may help treat the symptoms

of diverticulosis, prevent the onset of diverticulitis, and reduce the chance of

recurrent symptoms. Probiotics are live bacteria, like those normally found in

the GI tract. Probiotics can be found in dietary supplements — in capsules,

tablets, and powders — and in some foods, such as yogurt.1

Diverticulitis

Diverticulitis treatment depends upon the severity of the symptoms.

Home treatment

Mild symptoms of diverticulitis (mild abdominal pain, usually left lower

abdomen), can be treated at home with a clear liquid diet and oral

19


antibiotics. However, if one or more of the following signs or symptoms

develop, one should seek immediate medical attention:

• Temperature >100.1°F (38°C)

• Worsening or severe abdominal pain

• An inability to tolerate fluids

Hospital treatment

Moderate to severe symptoms, may require hospitalization for treatment.

During this time, the patient will not be allowed to eat or drink; IV fluids and

antibiotics will be administered.

If a colon abscess develops, the patient may need to have the abscess

drained. This is usually performed by placing a drainage tube across the

abdominal wall or by surgically opening the affected area.

Surgery

If a generalized infection in the abdomen develops, (peritonitis), an

emergency operation is usually required. A two-part operation may be

necessary in some cases.

The first operation involves removal of the diseased colon and creation of a

colostomy. A colostomy is an opening between the colon and the skin, where

a bag is attached to collect waste from the intestine. The lower end of the

colon is temporarily sewed closed to allow it to heal.

20


Approximately three to six months later, a second operation is performed to

reconnect the two parts of the colon and close the opening in the skin. The

patient will then be able to empty the bowel through the rectum. Sometimes

patients require up to a year to recover from the first operation, depending

on how sick they were. In non-emergency situations, the diseased area of

the colon can be removed and the two ends of the colon can be reconnected

in one operation, without the need for a colostomy.

An operation to remove the diseased area of the colon may not be necessary

if the patient improves with medical therapy. However, people who are

treated with an operation are felt to be cured, since only 15 percent of

people develop further diverticulosis after surgery and only 2 to 11 percent

of people need further surgery.4 Thus, surgery may be recommended for

people with repeated attacks of diverticulitis or if there are severe or

repeated episodes of bleeding. The decision depends in part upon other

medical conditions and ability to undergo surgery.

Some healthcare clinicians recommend surgery after the first attack of

diverticulitis in people who are less than 40 to 50 years. The reason for this

is that the disease may be more severe in this age group and there may be

an increased risk of recurrent disease that will ultimately require surgery.

Thus, having surgery at a young age could potentially eliminate the chances

of developing worsened disease.4

In many cases, an elective operation can be performed laparoscopically,

using small incisions, rather than the typical vertical abdominal incision.

21


Laparoscopic surgery usually allows for a faster recovery and a shorter

hospital stay.

Diverticular Bleeding

Diverticular bleeding is rare. Bleeding can be severe; however, it may stop

by itself and not require treatment. A person who has bleeding from the

rectum, even a small amount, should see a healthcare provider right away.

To treat the bleeding, a colonoscopy may be performed to identify the

location of and stop the bleeding. A CT scan or angiogram also may be used

to identify the site of the bleeding.

A traditional angiogram is a special kind of X-ray in which a thin, flexible

tube called a catheter is threaded through a large artery, often from the

groin, to the area of bleeding. Contrast medium is injected through the

catheter so the artery shows up more clearly on the X-ray. The procedure is

performed in a hospital or an outpatient center by an X-ray technician, and a

radiologist interprets the images. Anesthesia is not needed, though a

sedative may be given to lessen anxiety during the procedure.

If the bleeding does not stop, abdominal surgery with a colon resection may

be necessary. In a colon resection, the surgeon removes the affected part of

the colon and joins the remaining ends of the colon together; general

anesthesia is used. A blood transfusion may be needed if the person has lost

a significant amount of blood.1

22


Prognosis Of Diverticular Disease

Diverticulosis

Over time, diverticulosis may cause no problem or it may cause episodes of

bleeding and/or diverticulitis. Approximately 15 to 25 percent of people with

diverticulosis will develop diverticulitis, while 5 to 15 percent will develop


Diverticulitis

Approximately 85 percent of people with uncomplicated diverticulitis will

respond to medical treatment, while approximately 15 percent of patients

will need an operation. After successful treatment for a first attack of

diverticulitis, one-third of patients will remain asymptomatic, one-third will

have episodic cramps without diverticulitis, and one-third will go on to have

a second attack of diverticulitis. The prognosis tends to remain similar

following a second attack of diverticulitis. Only 10 percent of people remain

symptom-free after a second attack. Subsequent attacks tend to be of

similar severity, not increasing in severity as previously believed.4

Prevention Of Diverticular Disease

To prevent diverticular disease or reduce the complications from it, it is

important to maintain good bowel habits. This includes having regular bowel

movements and avoiding constipation and straining. Eating appropriate

amounts of the right types of fiber and drinking plenty of water and

exercising regularly will help keep bowels regulated.

23


The American Dietetic Association recommends 20 to 35 grams of fiber a

day. Every person, regardless of the presence of diverticula, should try to

consume 20 to 35 grams of fiber every day. Fiber is the indigestible part of

plant foods. High-fiber foods include whole grain breads, cereals, and

crackers, berries, fruit, vegetables (such as broccoli, cabbage, spinach,

carrots, asparagus, squash, and beans), brown rice, bran products, and

cooked dried peas and beans, among other foods. Drinking eight 8-ounce

glasses of water a day, monitoring changes in bowel movements (from

constipation to diarrhea) and getting enough rest and sleep, are other ways

to prevent diverticular disease.2

Summary

In summary, diverticular disease consists of three conditions that involve the

development of small sacs or pockets in the wall of the colon diverticulum)

including diverticulosis, diverticular bleeding, and diverticulitis. This course

has discussed these conditions, as well as their symptoms, causes, risk

factors, diagnosis, complications and treatment.

Please take time to help NurseCe4Less.com course planners evaluate the nursing knowledge needs met by completing the self-assessment of Knowledge Questions after reading the article, and providing feedback in the online course evaluation.

Completing the study questions is optional and is NOT a course requirement.

24


1. Diverticulosis specifically describes a. the presence of diverticula with symptoms. b. the presence of diverticula. c. the presence of diverticula with diverticular bleeding. d. inflammation of a diverticulum.

2. Inflammation of a diverticulum, known as ____________ occurs

when there is thinning and breakdown of the diverticular wall. a. diverticulosis b. colitis c. diverticulitis d. diverticular bleeding

3. A fistula is

a. a localized collection of pus. b. an abnormal tract between two areas that are not normally

connected. c. a blockage of the colon. d. an infection around the abdominal organ.


a. an abnormal tract between two areas that are not normally

connected. b. an infection around the abdominal organ. c. a blockage of the colon. d. an overwhelming body-wide infection.


a. when a small artery in a diverticulum erodes and bleeds into the

colon. b. in 25% of cases of simple diverticulitis. c. in 75 percent of all cases of diverticulitis. d. in all of the above.

6. True or False: A low-fiber diet is associated with diverticulosis

and an increased chance of diverticula. a. True b. False

25


7. In the colon, inflammation may be caused by ________________________. a. a decrease in healthy bacteria. b. a decrease in disease-causing bacteria. c. an increase in disease-causing bacteria. d. both a and c.

8. ____________ has been associated with an increase in risk of

both diverticulitis and diverticular bleeding. a. A low-fiber diet b. Lack of exercise c. Obesity d. Corn or popcorn consumption

9. ____________ appears to increase the risk for perforated

diverticulitis and a diverticular abscess. a. Smoking b. Consuming caffeine c. Alcohol consumption d. Inactivity

10. In testing for diverticular disease, a blood test may be ordered

by the healthcare provider to determine a. the presence of diverticula. b. the level of healthy bacteria. c. the presence of inflammation or anemia. d. levels of blood-alcohol.

11. Which of the following is the most common test used to

diagnose diverticular disease? a. Flexible sigmoidoscopy b. Computerized tomography (“CT”) scan of the colon c. Lower gastrointestinal (“GI”) series d. Colonoscopy

26


12. For several days, the patient’s stools may be white or light-colored because of ___________ in the large intestine after an enema. a. statins b. bacteria c. water d. barium

13. ______________________ is/are associated with an increased

risk of diverticulitis and diverticular bleeding. a. Statins b. Higher levels of vitamin D c. Alcohol consumption d. Steroids

14. One complication of acute diverticulitis may be

________________, which involves spilling intestinal contents into the abdominal cavity. a. peritonitis b. sepsis c. a fistula d. colitis

15. The usual treatment for a patient with diverticulitis who

develops an abscess is a. to drain the abscess. b. to surgically remove the abscess. c. to remove a small part of the intestine. d. to treat the patient with antibiotics.

16. Which of the following is true of diverticular bleeding?

a. It is common for patients with diverticulitis. b. It may stop by itself and not require treatment. c. Bleeding is never severe. d. A patient need only see a healthcare provider if the bleeding is

severe.

27


17. The American Dietetic Association recommends __________ grams of fiber a day. a. more than 50 b. 20 to 35 c. 10 d. 40 to 50

18. An procedure called __________________________ uses small

incisions, rather than the typical vertical abdominal incision, to treat diverticulitis. a. an angiogram b. flexible sigmoidoscopy c. laparoscopic surgery d. a colostomy

19. Diverticular disease involves the presence of _______________

in the wall of the colon. a. disease-causing bacteria b. bleeding c. small sacs or pockets d. an abscess

20. True or False: When treating diverticulosis, combining

mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more effective than using rifaximin alone. a. True b. False

28


Correct Answers:

1. Diverticulosis specifically describes

b. the presence of diverticula. “Diverticulosis merely describes the presence of diverticula.”

2. Inflammation of a diverticulum, known as ____________ occurs when there is thinning and breakdown of the diverticular wall.

c. diverticulitis “Inflammation of a diverticulum (diverticulitis) occurs when there is thinning and breakdown of the diverticular wall.”

3. A fistula is

b. an abnormal tract between two areas that are not normally connected. “Fistula - an abnormal tract between two areas that are not normally connected (i.e., bowel and bladder).”


d. an overwhelming body-wide infection. “Sepsis – overwhelming body-wide infection that can lead to failure of multiple organs.”


a. when a small artery in a diverticulum erodes and bleeds into the colon. “Diverticular bleeding occurs when a small artery located within a diverticulum is eroded and bleeds into the colon.”

29


6. True or False: A low-fiber diet is associated with diverticulosis and an increased chance of diverticula.

b. False “Scientists are not certain what causes diverticulosis and diverticular disease. For more than 50 years, the most widely accepted theory was that a low-fiber diet led to diverticulosis and diverticular disease. Two large studies also indicate that a low-fiber diet may increase the chance of developing diverticular disease. However, a recent study found that a low-fiber diet was not associated with diverticulosis and that a high-fiber diet and more frequent bowel movements may be linked to an increased rather than decreased chance of diverticula.”

7. In the colon, inflammation may be caused by

________________________.

a. a decrease in healthy bacteria. b. a decrease in disease-causing bacteria. c. an increase in disease-causing bacteria. d. both a and c. [Correct answer]

“In the colon, inflammation also may be caused by a decrease in healthy bacteria and an increase in disease-causing bacteria. This change in the bacteria may permit chronic inflammation to develop in the colon.”

8. ____________ has been associated with an increase in risk of

both diverticulitis and diverticular bleeding.

c. Obesity “Obesity has been associated with an increase in risk of both diverticulitis and diverticular bleeding.”

9. ____________ appears to increase the risk for perforated diverticulitis and a diverticular abscess.

a. Smoking “Current smokers appear to be at increased risk for perforated diverticulitis and a diverticular abscess as compared with nonsmokers. Caffeine and alcohol are not associated with an increased risk for symptomatic diverticular disease.”

30


10. In testing for diverticular disease, a blood test may be ordered by the healthcare provider to determine

c. the presence of inflammation or anemia. “The hemoglobin and complete blood count (CBC) blood test can show the presence of inflammation or anemia — a condition in which red blood cells are fewer or smaller than normal, which prevents the body’s cells from getting enough oxygen.”

11. Which of the following is the most common test used to

diagnose diverticular disease?

b. Computerized tomography (“CT”) scan of the colon “A CT scan is often used to diagnose diverticulitis and its complications. If diverticulitis (not just diverticulosis) is suspected, the above three tests should not be used because of the risk of perforation.”

12. For several days, the patient’s stools may be white or light-

colored because of ___________ in the large intestine after an enema.

d. barium “An enema involves flushing water or laxative into the rectum using a special squirt bottle…. For several days, traces of barium in the large intestine can cause stools to be white or light-colored.”

13. ______________________ is/are associated with an increased

risk of diverticulitis and diverticular bleeding.

d. Steroids “Several medications are associated with an increased risk of diverticulitis and diverticular bleeding including nonsteroidal anti-inflammatory drugs, steroids, and opiates.”

31


14. One complication of acute diverticulitis may be ________________, which involves spilling intestinal contents into the abdominal cavity.

a. peritonitis “Peritonitis [is] a medical emergency that requires immediate care, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into the abdominal cavity.”

15. The usual treatment for a patient with diverticulitis who

develops an abscess is

d. to treat the patient with antibiotics. “Antibiotic treatment of diverticulitis usually prevents or treats an abscess. If the abscess is large or does not clear up with antibiotics, it may need to be drained.”

16. Which of the following is true of diverticular bleeding?

b. It may stop by itself and not require treatment. “Diverticular bleeding is rare. Bleeding can be severe; however, it may stop by itself and not require treatment.”

17. The American Dietetic Association recommends __________

grams of fiber a day.

b. 20 to 35 “The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume 20 to 35 grams of fiber every day.”

18. An procedure called __________________________ uses small

incisions, rather than the typical vertical abdominal incision, to treat diverticulitis.

c. laparoscopic surgery “In many cases, an elective operation can be performed laparoscopically, using small incisions, rather than the typical vertical

32


abdominal incision. Laparoscopic surgery usually allows for a faster recovery and a shorter hospital stay.”

19. Diverticular disease involves the presence of _______________

in the wall of the colon.

c. small sacs or pockets “Diverticular disease consists of three conditions that involve the development of small sacs or pockets in the wall of the colon (called diverticulum) including diverticulosis, diverticular bleeding, and diverticulitis.”

20. True or False: When treating diverticulosis, combining

mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more effective than using rifaximin alone.

a. True “Research has also shown that combining mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more effective than using rifaximin alone to improve a person’s symptoms and maintain periods of remission.”

33


References Section

The References below include published works and in-text citations of published works that are intended as helpful material for your further reading.

1. Diverticular Disease (2013) National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved December 28, 2015 from www.niddk.nih.gov

2. Diverticulitis (2014) Mayo Foundation for Medical Education and Research. Retrieved December 18, 2015 from www.mayoclinic.org

3. Pemberton, J.H. & Young-Fadok, T. (2015) Clinical manifestations and diagnosis of acute diverticulitis in adults, in Lamont, J.T. (Ed.), UpToDate. Waltham, Mass.: UpToDate. Retrieved December 19, 2015 from www.uptodate.com

4. Young-Fadok, T. & Pemberton, J.H. (2015) Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis, in Friedman, L.S. (Ed.), UpToDate. Waltham, Mass.: UpToDate. Retrieved December 19, 2015 from www.uptodate.com

The information presented in this course is intended solely for the use of healthcare professionals taking this course, for credit, from NurseCe4Less.com. The information is designed to assist healthcare professionals, including nurses, in addressing issues associated with healthcare.

The information provided in this course is general in nature, and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals.

Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication.

Hospitals and facilities that use this publication agree to defend and indemnify, and shall hold NurseCe4Less.com, including its parent(s), subsidiaries, affiliates, officers/directors, and employees from liability resulting from the use of this publication.

The contents of this publication may not be reproduced without written permission from NurseCe4Less.com.

Documents

Diverticular Disease - NurseCe4Less.com · 28/12/2015 · Diverticulosis and diverticular disease are common in Western and industrialized countries — particularly the United States,