DIVERTICULITIS Acute inflammation and infection caused by trapped fecal material and bacteria in

the diverticulum that can impede the drainage and lead to perforation or abscess formation.

Diverticulum is outpouching of the mucosal lining of the GI tract commonly in the colon ( 95% is in sigmoid colon).

Diverticula /Diverticulitis are multiple outpouchings without inflammation or symptoms.

Causes:• Age• Low fiber diet• Chronic constipation• Obesity

Assessment: Dull, steady cramp-like lower left quadrant abdominal pain worsens with

movement, coughing, or staining Low-grade fever Chronic constipation with episodes of diarrhea Nausea and vomiting Abdominal distention and tenderness Occult bleeding, rectal bleeding, change in bowel movement Signs and symptoms of peritonitis due to development of abscess or perforation

Nursing Diagnosis: Constipation r/t narrowing of the colon from thickened muscular segments and

strictures Acute pain r/t inflammation and infection

Diagnostic Test:• Colonoscopy, sigmoidoscopy - visualization of diverticula • CBC- may reveal increased WBC• Barium enema - is NOT usually ordered in cases of acute inflammation because of

possibility of perforation

Medication Antibiotic

Trimethoprim/sulfamethoxazole or ciprofloxacin + metronidazole Addition of ampicillin to this regimen for nonresponders IV piperacillin or oral penicillin/clavulinic acid Rifixamin with fiber

Surgery: Colectomy -Surgical treatment involves removing the diseased part of the large

intestine (partial colectomy ) and reconnecting the remaining parts. Colostomy -A colostomy is a surgical procedure in which the upper part of the

intestine is sewn to an opening made in the skin of the abdomen. Stool passes out of the body at this opening and into a disposable bag. Usually the colostomy is removed at a later time and the intestine is reconnected.

- done when multiple surgeries are needed.

NURSING MANAGEMENT: Avoid nuts and popcorn Fluid intake 2500-3000ml/day High-fiber diet Avoid nuts and seeds which can be trapped in the diverticula. Bulk - forming laxative are ordered to restore normal bowel pattern

During acute episode: Bed rest NPO, clear liquids to rest bowel Avoid high-fiber foods to prevent further irritation of the mucosa Gradually increase the fiber when the infection or inflammation subside

HEMORRHOIDS- Are dilated portion of veins in the anal canalTYPES:

1. Internal hemorrhoids – above the internal sphincter2. External hemorrhoids – outside the external sphincter

CAUSES:- Chronic constipation- Pregnancy- Obesity- Prolonged sitting or standing- Wearing constricting clothing- Disease condition like liver cirrhosis and RSCHF

INTERNAL HEMORRHOID GRADEGrade 1 - Bleeding without prolapse Grade 2 - Prolapse with spontaneous reductionGrade 3 - Prolapse with manual reductionGrade 4 - Incarcerated, irreducible prolapse

NURSING MANAGEMENT:- High fiber diet- Increased fluid intake- Bulk laxatives- Hot sitz bath- Warm compress- Astringents ( e.g: witch hazel cream)- Bed rest- Local anesthetic application- Nupercaine

SURGERY:

Non-surgical treatments- Infrared photocoagulation - Bipolar diathermy- Laser therapy - Injection of sclerosing agents

Conservative surgical treatments- Hemorrhoidectomy - Cryosurgery- Rubber band ligation

( done only if hemorrhoids are INTERNAL )Stapled Hemorrhoidopexy - newer procedure uses surgical staples to treat prolapsing hemorrhoids.

Pre-op Care - Low residue diet - Stool softener

Post-op Care- Promotion of comfort

- Analgesic as prescribed - Positioning - Hot sitz bath 12-24 hours

- Promotion of elimination - Stool softener - Analgesic ( before initial defecation) - Encourage the client to defecate as soon as the urge occurs - Enema – as prescribed, using small-bore rectal tube