Download NFSC 370 diverticulosis

Elizabeth Musso
May 11, 2008
NFSC 370
Diverticular Disease and Colostomy Case Study
I. Pathophysiology:
Diverticulosis is the accumulation of saclike protrusions in the colonic wall. These “sacs”
are called diverticula. Diverticula develop in the muscular colonic wall because of mucosa and
submucosa herniations at weak areas (Aydin). Diverticulosis often does not have any symptoms
until it becomes diverticular disease, although 15-20% of people with diverticulosis experience
colicky pain (Mahan, 2008). Mr. Gonzalez experienced colicky pain. Diverticular disease can
cause hemorrhage and diverticulitis, which is inflammation of the diverticula. The cause of
diverticulosis is not clear but it is known to be caused by genetics, shape of the colon, and/or
predominantly a life-long diet that is low in fiber (Aydin). A lack of fiber can cause constipation,
which causes increased pressure of the colon. The pressure builds up and causes weak spots to
bulge out and become diverticula. Increased age is related to diverticulosis as well.
Diverticulosis prevalence is difficult to measure because it is usually asymptomatic, but it is
clear that it is becoming increasingly more common over time. It is most prevalent in Western
countries, where diets are low in fiber, and there is an increase in refined foods (Mahan, 2008).
A lack of exercise can also contribute to diverticulosis because exercise increases GI motility.
II. Biochemical Measurements:
Test
Hgb
Hct
Result
11g/dl
33%
Normal
14-17g/dl
42%-52%
Test
BUN
Creat
Result
12mg/dl
0.9mg/dl
Normal
5-20
0.6-1.2
K+
Na+
3.4 mEq/L
133mEq/L
3.6-5
134-145
ClWBC
97mEq/L
101-111
13 X 103/mm3 5-10x10³
Mr. Gonzalez’s hematocrit and hemoglobin levels are low due to the blood loss that passed
through his rectum, in his stool, from the erosion taking place in his sigmoid colon. A possible
broken blood vessel may have also caused bleeding. The blood loss is making his iron low.
Severe infections can also cause anemia because of an insufficient amount of iron for the
production of red blood cells (NAAC). The low K+, Na+, and Cl- values are because of his
diarrhea, where he is losing serum electrolytes (Mahan, 2008). The diarrhea may also have been
caused by the laxatives that he took. His white blood cell count is high due to the bacterial
infection of his colon (Tresca). The white blood cells are increasing to try and fight off the
bacteria.
III. Anthropometric Measurements:
Mr. Gonzalez’s IBW is (6lbs. x 7 in. + 106 lbs) = 148 lbs. +/- 10% = 133 lbs.-163 lbs. His
%IBW is 208lbs./148lbs. x 100 = 141%. His BMI is 208 lbs./67in./67in. x 703= 32.57. His
%IBW and BMI indicate that he is class I obese. It is clear that Mr. Gonzales needs to lose
weight. Weight loss would improve his conditions greatly and the exercise would help increase
his bowel movements as well.
IV. Drug Nutrient Interactions:
Tenex is a guanfacine hydrochloride that is used to help treat high blood pressure. Guanfacine
reduces heart rate and relaxes blood vessels. Tenex can cause dry mouth, constipation, and
sedation (guanfacine.com). Side effects include dizziness, drowsiness, headache, constipation,
gas pains, diarrhea, loss of appetite, fatigue, and nasal congestion (guanfacine.com). The Tenex
may be causing Mr. Gonzalez’s constipation, which does not help his diverticulosis situation at
all. Sine he has been taking Tenex for five years now, it may have participated in the cause of his
diverticular disease. The constipation has caused hard stools to cause pressure on his colon.
Mr. Gonzalez is also taking Ampicin, which is ampicillin. Ampicillin is a beta-lactam antibiotic
that is used to treat bacterial infections (AHFS). Ampicillin blocks transpeptidase, which is what
bacteria use to make cell walls. This is used to help destroy the bacteria in his diverticula.
Ampicillin can decrease the blood concentrations of estrogens in birth control pills and make
them less effective. When ampicillin is taken with allopurinol, it can cause a skin rash. Rashes in
patients who take ampicillin are common in general (medicine.net).
V. Medical Nutrition Therapy Recommendations:
The dietary recommendations for someone with diverticulosis would be a high-fiber diet. Mr.
Gonzalez’s fiber recommendation would be 38 grams/day, which is the DRI for men age 14-50
years old (medicine.net). Fiber should be increased slowly because it can cause gas for some
people. High fiber foods include whole wheat, oat, bran, vegetables, fruit, and legumes. White
bread, rice, and pasta should be replaced with whole wheat kinds (Puristat). Beans can be added
to salads and soups. Cereal is also usually a good source of fiber. Plenty of fluids (2-3 L per day)
are important for someone with diverticulosis as it helps keep things moving in the GI tract. A
fiber supplement, such as methylcellulose and psyllium, would be beneficial as well (Mahan,
2008). The dietary recommendation for someone with diverticulitis includes being on a lowresidue diet, which also means low-fiber. A low-residue diet is one in which stools are slowed
down so irritation of the diverticula can have time to get a break and heal. A low residue diet
would also ensure that no seeds or chunks will get into the sacs and further irritate them. Foods
to avoid on a low-residue diet include whole grains, bran, seeds, nuts, corn bread or muffins,
strong cheeses, yogurt with fruit chunks, raw vegetables, tough meat, millet, buckwheat, flax,
oatmeal, dried beans, dried fruits, chocolate, coconut, pepper, spicy foods, and caffeine.
Someone on a low-residue diet should eat white bread, pasta, and rice, mild dairy products, soft
vegetables, broths, tender meat, and juice without the pulp in it (Jackson).
In the period immediately following surgery, Mr. Gonzalez should be NPO and then advanced to
a clear liquid diet as soon as it can be tolerated. After liquids, Mr. Gonzales should advance to a
low-fiber, bland diet for about eight weeks (to allow for recovery time) so that obstructions are
prevented. Foods should not be stringy (such as tough meats) and should not have tough skins
that would be hard to digest (Northwestern). Mr. Gonzalez should be instructed to eat small
amounts of food at a time, to make sure they can be tolerated and his food should be thoroughly
chewed. We want to make sure Mr. Gonzalez heals correctly. After recovery, Mr. Gonzalez
should know that certain foods that are not completely digested will be seen in his pouch. These
foods would include corn, peanuts, cabbage, and mushrooms. There are also some foods that
cause odors, such as asparagus, eggs, fish, garlic, and onions. Odor reducers consist of
buttermilk, yogurt, parsley, and cranberry juice (Mahan, 2008). Mr. Gonzales should eat a well
balanced diet and skipping meals should never occur because it could increase gas, which would
cause pressure and discomfort (Northwestern). Using straws, chewing gum, eating fast, inactivity
and lying down after eating can all cause gas. It is important for Mr. Gonzalez to have a good
support group, such as his children, who can be sensitive to his condition and help him get
through recovery and learning how to use his pouch. Since Mr. Gonzalez has a family history of
CHD, intestinal cancer, myocardial infarctions, it is important for him to lose weight, stay active,
and eat well balanced meals with plenty of fluids. If Mr. Gonzalez follows these
recommendations, he should be on a speedy road to recovery.
References
Aydin, H and Remzi, F. Colonic Diverticular Disease. 2004.
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/colonic/c
olonic.htm
Jackson Siegelbaum Gastroenterology. Low Fiber Low Residue Diet. 2006.
http://www.gicare.com/pated/edtgs02.htm
Mahan, K. and Escott-Stump, S. Krause’s Food & Nutrition Therapy. Canada. Saunders. 2008.
Medicine.net. 1997. http://www.medicinenet.com/ampicillin/article.htm
National Anemia Action Council. 2008. http://www.anemia.org/patients/faq/
Northwestern Memorial Hospital. A Patient Guide to Colostomy Care. 2008.
http://www.nmh.org/nmh/patientinformation/patientguidecolostomycare.htm
Puristat Internal Cleansing. Diet for Diverticulosis. 2008.
http://www.puristat.com/conditions/dietfordiverticulitis.aspx
The Reference Site for Guanfacine. http://www.guanfacine.com/
Tresca, A. White Blood Cell Count. About. Com. 2008.
http://ibdcrohns.about.com/od/diagnostictesting/p/testwbc.htm