Diverticulitis

Introduction

Diverticulitis has become one of the most common diseases in the Western world, which affects the digestive tract. Diverticulitis is a serious condition that causes small, bulging pouches on the lining of the digestive system, especially in the lower part of the colon. For people who are above the age of 40 years, the complication can be common and often pose serious problems. The pouches formed can become inflamed or infected, which now marks the onset of the condition Diverticulitis. The pouches are weak spots that allow bacteria to gather and cause infection. The condition once it strikes, causes severe abdominal pain, significant bowel habit changes, fever, and nausea. 

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Common Signs and Symptoms

According to Carabotti, Annibale, Severi, and Lahner (2017), only 4% of a typical American population will have Diverticulitis and of those, only 15% will experience complications. Sallinen, Mali, Leppäniemi, and Mentula (2015) explain that for people who have had an episode of Diverticulitis, 39% of such individuals will have another attack from the complication within five years. The same study continues to say that the first attack is the worst one since, in future, the scar tissue will prevent future perforations. As such, those with mild episodes, have a good chance of avoiding serious recurrences. When the complication becomes severe and chronic, then the condition escalates and becomes serious. According to Bugiantella et al. (2015), such chronic Diverticulitis can be treated using surgical procedures. 

According to Baum & Companioni (2018), patients with Diverticulitis experience a left lower quadrant abdominal pain and tenderness. Often patients have a palpable sigmoid and the pain is occasionally suprapubic. The pain of patients with Diverticulitis is often accompanied by nausea, fever, and vomiting. Sometimes, the patient might have a urinary symptom, which results from bladder irritation. Patients might experience peritoneal signs with an abscess. Bleeding is uncommon although Onur, Akpinar, Karaosmanoglu, Isayev, and Karcaaltincaba (2017) explain that 17% of people with chronic diverticulitis will experience bleeding.  

Screening Assessment Tools and Recommended Diagnostic Tests

Different health conditions are similar to the perspectives of symptoms to those of diverticulitis and as such, it is imperative to conduct several tests to rule out other similar cases. A nurse practitioner or any other clinician will be interested in knowing the symptoms from the patient’s perspective, the patient’s health history, and any other medications that the patient is taking. A physical examination to check the abdomen for tenderness is necessary. Further, a digital rectal exam is necessary to check for aspects such as bleeding, masses and other problems. 

According to Wensaas and Hungin (2016), different tests can be conducted to diagnose the complication such as blood tests to confirm the status of aspects such as inflammation, anemia, or kidney/liver problems. A urine test is necessary to detect and rule out different types of infection. A stool test is necessary to detect gastrointestinal infections, such as Clostridium difficile. To rule out gynecologic problems in women, a pelvic exam is necessary. Pregnancy tests in women are also necessary to rule out pregnancy complications with women. 

After ruling out other possibilities using the tests described above, conclusive tests are necessary. Imaging tests, for instance, abdominal ultrasound or the abdominal CT Scan to give images of the gastrointestinal tract. A Barium enema test can be done, which is a form of an x-ray test that involves the use of liquid material through the colon to get the outline of the colon and identify large polyps/growth or diverticula are present on the walls of the colon. Colonoscopy can also be done as it will show the inside of the colon and will show abnormalities in the colon. 

Treatment Plans

Non-pharmacologic treatment of diverticulitis is possible. Lots of rest and high fluid intake is encouraged to help the patient recover from symptoms as explained by Bugiantella et al. (2015). Pharmacologic treatment of diverticulitis includes the use of antibiotics, radiologic guided drainage, surgery, and temporary colostomy. With acute conditions, patients should be hospitalized and administered with antibiotics for 7 to 10 days, which include Metronidazole 500mg 8h plus fluoroquinolone 500 mg 12 h or Metronidazole 500mg 8h plus sulphamethoxazole 800/16 mg 12 h. The antibiotic regimen is based on selected factors such as the severity of the illness or adverse outcome. According to Feingold et al. (2014), surgery can be a necessary option depending on the severity of the complication, especially for patients with perforation. A temporary colostomy is required during complicated surgery. Radiologic guided drainage, which is a tube placed in the abdomen to drain large abscesses

Conclusion

Diverticulitis has been seen to be a serious illness that calls for serious medical intervention, especially in acute cases. Patients are advised to take fluid foods and be diagnosed by medical professions to rule out other possible causes. Patients who are critically ill need to be hospitalized and administered with a regime of antibiotics to help with the problem. Depending on the determination of the medical examination and diagnosis, patients might be booked for surgery.

References

Bugiantella, W., Rondelli, F., Longaroni, M., Mariani, E., Sanguinetti, A., & Avenia, N. (2015). Left colon acute diverticulitis: an update on diagnosis, treatment, and prevention. International Journal of surgery, 13, 157-164.

Carabotti, M., Annibale, B., Severi, C., & Lahner, E. (2017). Role of fiber in symptomatic uncomplicated diverticular disease: a systematic review. Nutrients, 9(2), 161.

Onur, M. R., Akpinar, E., Karaosmanoglu, A. D., Isayev, C., & Karcaaltincaba, M. (2017). Diverticulitis: a comprehensive review with usual and unusual complications. Insights into imaging, 8(1), 19-27.

 Sallinen, V., Mali, J., Leppäniemi, A., & Mentula, P. (2015). Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence. Medicine, 94(8).Wensaas, K. A., & Hungin, A. P. (2016). Diverticular disease in the primary care setting. Journal of clinical gastroenterology, 50, S86-S88.

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