Diverticular disease

• diverticulum is a sacklike herniation of the lining of esophagus/bowel that extends through a defect in the muscle layer
• meckel's diverticulum - a pouch on the wall of the lower part of the intestine that is present at birth (congenital)
• diverticulosis - presence of multiple diverticula
• diverticulitis - results when food and bacteria retained in a diverticulum produce infection and inflammation
• Predisposing factors

  • lower fiber intake
  • developed countries
  • increasing age
• Pathophysiology:

  • high intraluminal pressure
  • low fiber
  • decreased muscle strength
• manifestations:

  • preceded by chronic constipation
• manifestations: (mild)

  • diarrhea
  • anorexia, nausea
  • bloating
  • weakness
• manifestations: (diverticulitis)

  • LLQ pain
  • fever
  • leukocytosis
• assessment & diagnostic findings:

  • colonoscopy
  • barium enema - contraindicated for diverticulitis because of the potential perforation
• assessment & diagnostic findings:

  • ct with contrast - test of choice with diverticulitis
  • abdominal x-ray
• assessment & diagnostic findings:

  • cbc: increased wbc
  • elevated esr
• management:

  • rest
  • diet (npo to clear liquid to high fiber, low fat)
• management (pharmacologic)

  • antibiotics
  • antispasmodics
  • bulk-forming laxatives
  • opioid analgesic
  • stool softeners
  • suppository