1. Adult Medical- Surgical Nursing
Gastro-intestinal Module: Diverticular Disease:
(Diverticulosis/ Diverticulitis)

2. Diverticular Disease: Incidence and Aetiology
A condition of the colon, often affecting the sigmoid
Mostly found in the elderly
Associated with a low fibre diet, dehydration, constipation and straining to defaecate
The elderly often present with diverticulitis, inflammation and infection of the colon

3. Diverticular Disease: Pathophysiology
With straining to defaecate, the submucosal and mucosal layers of the colon herniate through the muscle forming pockets (diverticulosis)
The pockets can trap faecal matter and become inflamed (diverticulitis)
Local inflammation → bowel irritability/ spasticity
Abscesses may form, which may:
Perforate → peritonitis (acute abdomen) or
Erode a blood vessel (haemorrhage and malaena)
Healing causes fibrosis and strictures, increasing constipation and risk of sub-acute or acute obstruction

4. Diverticulosis: Clinical Manifestations
Left-sided lower abdominal pain
Nausea/ anorexia
Low grade fever
Abdominal distension
Constipation
Weight loss/ malnutrition

5. Diverticulitis: Clinical Manifestations
Acute, severe pain in the left lower abdomen
Fever (may lead to septicaemia: hyperpyrexia and rigors)
Constipation (may be silent bowel: no bowel sounds)
If perforation, symptoms of peritonitis (shock)
Rectal bleeding and malaena

6. Diverticular Disease: Medical Treatment
Rest the bowel while inflamed (clear fluids)
→ once settled, a high fibre, low fat diet
Antibiotic course
Bulk-forming laxative (Fybogel)
Anti-spasmodic (Probanthin, Buscopan)
Pain relief (avoid codeine as constipating)
Stool-softening agent when hard, or glycerin suppositories

7. Diverticulitis: Emergency Treatment
25% of patients with diverticulitis require immediate surgical intervention for an “acute abdomen”: perforation, abscess, peritonitis, haemorrhage, obstruction
Antibiotic cover
Surgical resection with end-to-end anastamosis
Resection with double-barrel colostomy and later anastamosis
If sub-acute, antibiotics and elective “cold” surgery may be required later

8. Diverticular Disease: Nursing Considerations
Patient teaching about diet, exercise and bowel habit
If surgery required: pre- and post-operative nursing of a patient undergoing bowel resection
Colostomy care and patient education:
Observe stoma is healthy (active, red & shiny)
Care of colostomy and surrounding skin
Management of diet with colostomy

9. Diverticular Disease: Bowel Resection Pre-operative Care
Emergency operation:
General physical check-up, chest Xray, ECG
Blood profile, IVI, group and cross-match (GXM)
Breathing exercises to prepare for post-op
Thrombo-embolism stockings/ prophylactic heparin
Explanation of operation and possible stoma, consent and emotional support
Nil orally pre-op

10. Bowel Resection: Post-operative Care
Regular pain relief
Monitor vital signs, pulse oximetry, IV fluids, urine output and fluid balance
Semi-sitting position once recovered
Breathing and leg exercises. Early ambulation
Low molecular dose heparin. IV antibiotics
Nil by mouth (NPO) initially→ graduated intake (mouth care)
Nasogastric tube aspirations, wound, drain care, stoma care