Glossary of Medical 4-MS61-Diverticular Disease
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- What are diverticula?
(Diverticulosis are multiple diverticula...diverticulitis is the inflammation of one or more diverticula)
- congenital or acquired pouchlike herniations of mucosa through the muscular wall of small intestine or colon
- Where can diverticula occur?
- in any part of small or large intestine, but occur mostly in SIGMOID COLON
- Define etiology?
- cause of disease
- Define pathophysiology?
- the study of how normal physiological processes are altered by disease
- Describe the pathophysiology of the formation of diverticula?
it becomes herniated...so where do diverticula seem to occur?
ha! as part of the aging process
- the musculature of the colon hypertrophies, then thickens, then becomes rigid...and then what happens to the mucosa and submucosa of the colon wall?
hmmm...at points of weakness in the intestinal wall, often at areas where blood vessels interrupt muscular continuity....and how does muscle weakness develop, you in the back?
- All by themselves, diverticula cause few problems. However, if _____ or ______ become trapped in a diverticulum, however, blood supply to that area _______ and bacteria invades the diverticulum. And so how does diverticulis result from there?
the diverticulum perforates and a local abscess forms....and so what can form if the perforated diverticulum progresses to intra-abdominal perforation?
- What range can bleeding from diverticula occur in? (3)
- What is minor bleeding of diverticula due to?
vascular granulation...at the base of?
- localized inflammation in areas of ________ ______ tissue?
- Hemorrhage can result when a ______ _____ is eroded within a diverticulum
- blood vessel
- What can lead to narrowing of the bowel lumen, and resultant obstruction?
fistulas to other organs, such as bladder and vagina.
- inflammation...and so inflammation can also result in ______?
- What has been implicated in the development of diverticula?
- diets with small amounts of fiber because they cause less bulky stool and possible constipation
- What must happen for diverticulosis and diverticulitis to occur?
- there must be an increase in intraluminal pressure and muscle contractions to move fecal material through the colon
- What is the etiologic factor in diverticulitis?
- retained undigested food in diverticula, which compromises blood supply to that area and facilitates bacterial invasion of the sac
- Diverticulitis affects what percentage of adults over age 60?
- one third, more men than women...only one in 5 display symptoms
- Most clients are asymptomatic, and unless _____ or _____ develops,
the condition may go undiagnosed or found incidentally on routine ________.
- Uncomplicated diverticulosis that causes symptoms might have ________and _________ and possible rectal _____ and INTERMITTENT pain in which part of the body?
- constipation (may be due to intestinal inflammation)
left lower quadrant
- With diverticulosis, abdominal PALPATION might elicit occasional _______.
The ______ may be PALPABLE.
- The INTERMITTENT pain in LLQ associated with onset of diverticulosis may get progressively STEADY...may be _______, or on one side.
- Abdominal pain will be generalized if _______ has occurred.
- Patient's temperature is elevated, ranging from low grade fever to. _______ may be secondary to fever.
Nausea and vomiting are commonly present.
- When examining abdomen, observe for ________.
- What should the patient report if localized peritoneal irritation is present?
- localized muscle spasm
If generalized peritonitis is present, these symptoms will be more?
- The HCP may PALPATE a tender mass during rectal exam if the perforated diverticulum is close to the?
- Blood pressure checks may show?
- orthostatic changes
- If bleeding is massive, the patient may have ________
and _________ ?
shock....what can happen if generalized peritonitis has occurred?
this may result in?
sepsis and manifestations of hypotension and septic or hypovolemic shock can occur
- With diverticulosis, WBC will?
decrease if chronic or severe bleeding is present
- increase...hematocrit and hemoglobin will?
- FOBT (fecal occult blood test) are _______ in 20% of cases
- Urinalysis may show a few ____ if the left ureter is in proximity to a perforated diverticulum
- X-rays (show diverticula)
upper GI series (show small
barium enema (shows large
- A barium enema exam will usually not be performed in acute phase of diverticulitis because?
after the patient has been treated with antibiotics and inflammation has resolved.
- there's a risk of rupture of inflamed diverticulum....so when is a barium enema done?
- A CT scan may be ordered to diagnose?
- an abscess or thickening of the bowel related to diverticulitis.
- Ultrasonography, noninvasive, may reveal?
- bowel thickening or an abscess
- The doctor may perform a _________ or ________ after the ACUTE PHASE of the illness, usually to rule out presence of tumor in large intestine, particularly if patient has rectal bleeding...there is a risk for perforation.
- If symptoms are mild, patient may be treated outpatient. This would be done if temp is lower than _____ and WBC ranges from ______ to _________.
Monitor patient for prolonged or increased _____,
__________, or _______ in stool.
13,000 to 15,000/mm3
- Nonsurgical management is a combination of ______ and _____ therapy with rest to decrease inflammation and improve tissue perfusion.
Start antibiotics, such as?
metronidazole (Flgyl) plus
azole (Bactrim, Septra) or
ciprofloxacin (Cipro) and
mild analgesic for pain.
- If patient has severe pain, then admit to hospital and prescribe ____ _____ to correct ______ as well as IV
meperidine hydrochloride (Demerol) or morphine sulfate.
What about laxatives?
instruct the client to
- IV fluids
antibiotics (cefoxitin plus
What kind of opioid analgesic might be prescribed to alleviate pain?
Laxatives are avoided because they increase intraluminal pressure. Nurse should monitor fluid and electrolytes continually.
What should the nurse instruct the patient to do to keep from perforating the diverticulum?
restrict to clear liquids...more severe cases stay NPO...when should an NG tube be inserted?
fiber-containing unless acute phase returns, then stop fiber-containing diet
- Surgical management is indicated for the following?
- rutpure of diverticulum
with subsequent peritonitis
persistent fever or pain
after 4 days of medical
- Surgeon performs emergency surgery if? (3)
- What is the most common surgical procedure for clients with diverticular disease?
- colon resection, with or without a colostomy
- What category of meds can be prescribed for geriatric with diverticulitis?
- What are possible side effects of antibiotics,
analgesics, and anticholinergics which may be prescribed for geriatric patients with diverticulitis?
- confusion (or increased
- Give laxatives or enemas to geriatric patient with diverticulitis?
- Discourage geriatric patients from activities that increase ______-_______
pressure, such as straining and bending and have them rest instead.
- In geriatric patients with active diverticulitis, provid a diet that is?
- low-fiber...when inflammation resolves, provid a _____ _____ diet.
- Geriatric patients with diverticulitis do not always present with typical pain or fever expected, so observe carefully for signs of active disease.
- Perform frequent abdominal assessments to determine ______ and _______ on PALPATION of geriatric diverticulitis patients.
- In geriatric patients with diverticulitis, check stools for _______ or ________ bleeding.
- If the patient is NOT in the ACUTE phase of diverticulitis, a thorough bowel preparation MAY be given, consisting of laxatives daily for _____ to _____ days before surgery.
perforation...so, in the end, what is the deciding factors on whether
- 1 to 2 days...however doctor may forgo this because of the risk of?
if patient has an acutely inflamed diverticulum...OR persistent fever and abdominal pain.
- For patients without acute inflammation, what is the well-structured diet plan? (3 stages)
- 4-5 days...low-fiber...then 2 days of full-liquid diet...then a romantic clear liquid diet the eve of surgery
- Preop teaching for colostomy may be indicated by an ET or office nurse if client so desires.
- Define anastomosis?
- a natural communication between 2 vessels, may be direct or by means of connecting channels...the pathological connection of two tubular structures
- What is the operative procedure for a patient with diverticulitis...First of all, what part is resected?
the portion that is inflamed or diseased....how can doctor restore patency?
inflammation and infection...then what's the altern
- colon...but which part?
by creating an anastomosis or tubular connection....what may keep the surgeon from creating an anastomosis?
a colostomy...what does the patient then undergo in 3 to 6 months if all goes okay?
- Immediate physical care for clients undergoing a colon resection is?
- same as clients undergoing abdominal surgery.
- Post-op, the patient has a drain in place at the abdominal incision for how many days?
it's not draining yet, so use a peteroleum gauze dressing...what alternative measure can be taken?
then monitor for color and integrity..so what
- 2 to 3 days....how should nurse dress the colostomy for those 2 days?
place a colostomy bag over stoma...what if the stoma is visible?
pinkish to cherry red without retraction or prolapse into abdomen
- How is a colon resection client maintained for 2 to 3 days whether he has a colostomy or not?
when peristalsis returns...and according to HCPs orders...then the patient can have what?
- on NPO status with a possible NG tube....well, when should the NG tube be removed?
hmm...clear liquids SLOWLY and then GRADUALLY advance to solids, depending on return of peristalsis and bowel function.
- If the patient has had a successful colostomy created, when should it begin functioning?
- in 2 to 4 days
- What is the most common site for diverticulitis?
drainage will be loose, but eventually formed so be sure to get a tight seal around the stoma to avoid contact with feces and skin.
- sigmoid colon....so that's where most patients undergo surgery such as a sigmoid colostomy...and what kind of stools can we expect from this type of surgery?
- What's the average length of hospitalization for diverticulitis patients?
- 3 days to longer than a week
- Home care management for patient following diverticulitis operation is?
- diet management of high-fiber
possible colostomy care
- What does a patient with diverticulosis need to know about diet?
cellulose and hemicellulose...these materials are found in what kinds of foods?
25 to 35 g of fiber per day, found in 4 slices of 100% whole-wheat bread and a 3-ounce
- that dietary fiber can regulate bowel function and bring about partial relief of symptoms...a diet high in what?
and how many grams of fiber should the patient ingest?
then introduce them gradually to avoid flatulence and abdominal cramping...and what if the symptoms are too severe to continue this diet regimen?
ample fluid intake will help prevent bloating that may accompany a high-fiber diet...and AVOID alcohol because it irritates the bowel...what should clients AVOID at all costs?
alright then...nuts, corn, popcorn, cucumbers, tomatoes, figs, strawberries, caraway seeds...and how about allowable percentage of fat?
- Patients should AVOID ALL FIBER when they have symptoms of?
because they're IRRITATING!
BUT!...as diverticulitis resolves, fiber can be gradually added until progression to a high-fiber diet is once again obtained.
This could happen
- diverticulitis because why?
- What should the nurse instruct the patient to do at some point following discharge from the hospital for diverticular disease?
- 1 month FU visit to HCP
repeat flexible sigmoidoscopy
or barium enema can be
performed at that time
if patient had surgery, then
give instructions on
incision care and signs
and symptoms to report to
provide instruction on
colostomy care if received
- What are the manifestations of acute diverticular disease?
bloody, mahogany, or tarry
avoid laxatives other than
avoid activities that
pressure, such as
straining at stool,
bending, or lifting heavy
can be resolved with proper
doesn't commonly recur if
everything done right
discuss alteration of body
image and loss of body
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