1. Diverticular disease of the colon Presented by J. Karl Pineda

2. Pathophysiology Diverticular disease may involve any part of the GI tract. Typically acquired, diverticular disease may be congenital, such as Meckel iliac diverticulum (although this is rare). Diverticula are herniations of the mucosa and submucosa or the entire wall thickness through the muscularis, as seen in congenital diverticula. The sigmoid is the most commonly affected (95-98%)

3. Pathophysiology Diverticular disease also can involve the descending, ascending, and transverse colon as well as the jejunum, ileum, and duodenum The penetration of fecal matter through the thin-walled diverticula causes inflamation and abscess formation in the tissue surrounding the colon.

4. Signs and Symptoms Constipation and diarrhea accompanied by pain in the lower-left quadrant Flatus, anorexia, and nausea Abdominal distention, low grade fever, vomiting, and blood in the stool

5. Diagnostic Tests CT scan with oral contrast

6. Diagnostic Test X ray Thumbprinting on left mid quadrant

7. Diagnostic Tests CBC Urinalysis Fecal occult blood tests Barium enema determine narrowing or obstruction of the lumen Colonoscopy If patient has acute diverticulitis barium enmas are contraindicated (perforation & peritonitis)

8. Medical Management Low residue diet Stool softners Bed rests Sulfa drugs Analgesics GoLYTELY in elective surgery Hartmann’s procedure

10. Medications Laxatives Antibiotics

11. Nursing Intervention

12. Interventions IV fluids and an NG tube for first few day post operatively if bowel activity has not retuned PT teaching Comfort measures and the assessment of pain Teach patient colonoscopy care when patient is free of pain

13. Prognosis Good with 30% of patients needing bowel resection of the affected part in acute case to reduce mortality and morbidity