Download 1 Diverticular Disease Elizabeth Boldon, RN, MSN Elizabeth Boldon

1
Diverticular
Disease
Elizabeth Boldon, RN, MSN
Elizabeth Boldon is a Nurse Education Specialist
at Mayo Clinic in Rochester, Minnesota. She
received a BSN from Allen College in Waterloo,
Iowa in 2002 and an MSN with a focus in
education from the University of Phoenix in 2008. She has bedside nursing
experience in medical neurology and the neuroscience ICU.
Abstract
Diverticular disease is a common disease associated with significant potential
complications. Colonoscopy, X-rays and possibly computed tomography (CT)
assist in the diagnosis of diverticulosis and potential complications. Initial
therapy and treatment of complications, such as infection and bleeding,
related to diverticulosis are discussed, which includes endoscopic and
surgical interventions.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
2
Continuing Nursing Education Course Planners
William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster,
Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner
Policy Statement
This activity has been planned and implemented in accordance with the
policies of NurseCe4Less.com and the continuing nursing education
requirements of the American Nurses Credentialing Center's Commission on
Accreditation for registered nurses. It is the policy of NurseCe4Less.com to
ensure objectivity, transparency, and best practice in clinical education for
all continuing nursing education (CNE) activities.
Continuing Education Credit Designation
This educational activity is credited for 2 hours. Nurses may only claim credit
commensurate with the credit awarded for completion of this course activity.
Statement of Learning Need
Clinicians need to be able to recognize the symptoms of diverticular disease.
Patients with diverticular disease are at risk to develop infection and
bleeding. Current trends in the diagnosis and treatment of diverticular
disease are essential for the clinician to understand in order to appropriately
and safely manage the condition.
Course Purpose
To provide nursing professionals with knowledge to care for patients with
diverticular disease.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
3
Target Audience
Advanced Practice Registered Nurses and Registered Nurses
(Interdisciplinary Health Team Members, including Vocational Nurses and
Medical Assistants may obtain a Certificate of Completion)
Course Author & Planning Team Conflict of Interest Disclosures
Elizabeth Boldon, RN, MSN, William S. Cook, PhD,
Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC –
all have no disclosures
Acknowledgement of Commercial Support
There is no commercial support for this course.
Activity Review Information
Reviewed by Susan DePasquale, MSN, FPMHNP-BC
Release Date: 1/7/2016
Termination Date: 1/7/2019
Please take time to complete a self-assessment of knowledge, on
page 4, sample questions before reading the article.
Opportunity to complete a self-assessment of knowledge learned
will be provided at the end of the course.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
4
1.
Diverticulosis specifically describes
a. the presence of diverticula with symptoms.
b. the presence of diverticula.
c. the presence of diverticula with diverticular bleeding.
d. inflammation of a diverticulum.
2.
Inflammation of a diverticulum, known as
___________________ occurs when there is thinning and
breakdown of the diverticular wall.
a. diverticulosis
b. colitis
c. diverticulitis
d. diverticular bleeding
3.
A fistula is
a. a localized collection of pus.
b. an abnormal tract between two areas that are not normally
connected.
c. a blockage of the colon.
d. an infection around the abdominal organ.
4.
Sepsis is defined as
a. an abnormal tract between two areas that are not normally
connected.
b. an infection around the abdominal organ.
c. a blockage of the colon.
d. an overwhelming body-wide infection.
5.
Diverticular bleeding occurs
a. when a small artery in a diverticulum erodes/bleeds into the colon.
b. in 25% of cases of simple diverticulitis.
c. in 75 percent of all cases of diverticulitis.
d. All of the above.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
5
Introduction
Diverticular disease of the colon is an important cause of hospital admissions
and a significant contributor to healthcare costs in the United States.
Diverticular disease consists of three conditions that involve the
development of small sacs or pockets in the wall of the colon (called
diverticulum) including diverticulosis, diverticular bleeding, and
diverticulitis.3 This course will describe all three of these conditions, as well
as their symptoms, causes, risk factors, diagnosis, complications and
treatment.
What Is Diverticular Disease?
Diverticular disease is defined as clinically significant and symptomatic
diverticulosis due to diverticular bleeding, diverticulitis, segmental colitis
associated with diverticula, or symptomatic uncomplicated diverticular
disease.
Diverticulosis
Diverticulosis merely describes the presence of diverticula. Diverticulosis is
often found during a test done for other reasons, such as flexible
sigmoidoscopy, colonoscopy, or barium enema. Most people with
diverticulosis have no symptoms and will remain symptom free for the rest
of their lives.3 A person with diverticulosis may have diverticulitis, or
diverticular bleeding.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
6
Diverticulitis
Inflammation of a diverticulum (diverticulitis) occurs when there is thinning
and breakdown of the diverticular wall. This may be caused by increased
pressure within the colon or by hardened particles of stool, which can
become lodged within the diverticulum.
The symptoms of diverticulitis depend upon the degree of inflammation
present. The most common symptom is pain in the left lower abdomen.
Other symptoms can include nausea and vomiting, constipation, diarrhea,
and urinary symptoms such as pain or burning when urinating or the
frequent need to urinate.
Diverticulitis is divided into simple and complicated forms.

Simple diverticulitis, which accounts for 75 percent of cases, is not
associated with complications and typically responds to medical
treatment without surgery.

Complicated diverticulitis occurs in 25 percent of cases and usually
requires surgery. Complications associated with diverticulitis can
include the following:3
o Abscess – a localized collection of pus
o Fistula – an abnormal tract between two areas that are not
normally connected (i.e., bowel and bladder)
o Obstruction – a blockage of the colon
o Peritonitis – infection involving the space around the abdominal
organ
o Sepsis – overwhelming body-wide infection that can lead to
failure of multiple organs
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
7
Diverticular Bleeding
Diverticular bleeding occurs when a small artery located within a
diverticulum is eroded and bleeds into the colon. Diverticular bleeding
usually causes painless bleeding from the rectum. In approximately 50
percent of cases, the person will see maroon or bright red blood with bowel
movements.3,4
Symptoms Of Diverticular Disease
People with diverticulitis may have many symptoms, the most common of
which is pain in the lower left side of the abdomen. The pain is usually
severe and comes on suddenly, though it can also be mild and then worsen
over several days. The intensity of the pain can fluctuate. Diverticulitis may
also cause:

fevers and chills

nausea or vomiting

a change in bowel habits — constipation or diarrhea

diverticular bleeding
In most cases, people with diverticular bleeding suddenly have a large
amount of red or maroon-colored blood in their stool. Diverticular bleeding
may also cause:1

weakness

dizziness or light-headedness

abdominal cramping
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
8
Causes Of Diverticular Disease
Diverticulosis is often found during tests performed for other reasons.4

Barium enema
This is an x-ray study that uses barium in an enema to view the
outline of the lower intestinal tract. This is an older test and has been
largely replaced by computed tomography (CT) scan.

Flexible sigmoidoscopy
This is an examination of the inside of the sigmoid colon with a thin,
flexible tube that contains a camera.

Colonoscopy
This is an examination of the inside of the entire colon.

CT scan
A CT scan is often used to diagnose diverticulitis and its complications.
If diverticulitis (not just diverticulosis) is suspected, the above three
tests should not be used because of the risk of perforation.
Scientists are not certain what causes diverticulosis and diverticular disease.
For more than 50 years, the most widely accepted theory was that a lowfiber diet led to diverticulosis and diverticular disease. Diverticulosis and
diverticular disease were first noticed in the United States in the early
1900s, around the time processed foods were introduced into the American
diet. Consumption of processed foods greatly reduced Americans’ fiber
intake.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
9
Diverticulosis and diverticular disease are common in Western and
industrialized countries — particularly the United States, England, and
Australia — where low-fiber diets are common. The condition is rare in Asia
and Africa, where most people eat high-fiber diets. Two large studies also
indicate that a low-fiber diet may increase the chance of developing
diverticular disease. However, a recent study found that a low-fiber diet was
not associated with diverticulosis and that a high-fiber diet and more
frequent bowel movements may be linked to an increased rather than
decreased chance of diverticula.1
Other studies have focused on the role of decreased levels of the
neurotransmitter serotonin in causing decreased relaxation and increased
spasms of the colon muscle. However, more studies are needed in this area.
Studies have also found links between diverticular disease and obesity, lack
of exercise, smoking, and certain medications including nonsteroidal antiinflammatory drugs, such as aspirin, and steroids.
Scientists agree that with diverticulitis, inflammation may begin when
bacteria or stool get caught in a diverticulum. In the colon, inflammation
also may be caused by a decrease in healthy bacteria and an increase in
disease-causing bacteria. This change in the bacteria may permit chronic
inflammation to develop in the colon.1
Risk Factors For Diverticular Disease
Environmental and lifestyle factors are important risk factors for diverticular
disease.3,4
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
10
Diet
Fiber
The role of fiber in the development of diverticulosis is unclear. Several early
studies suggested that low dietary fiber predisposes to the development of
diverticular disease, but other studies have been conflicting. Fiber also does
not reduce symptoms in patients with symptomatic uncomplicated
diverticular disease. However, dietary fiber and a vegetarian diet may
reduce the incidence of symptomatic diverticular disease by decreasing
intestinal inflammation and altering the intestinal microbiota.
Fat and Red Meat
In one study, the risk of diverticular disease was significantly increased with
diets that were low in fiber and were high in total fat or red meat as
compared with diets that were low in both fiber and total fat or red meat.
Seeds and Nuts
Nut, corn, and popcorn consumption are not associated with an increase in
risk of diverticulosis, diverticulitis or diverticular bleeding. In addition, no
association has been found between consumption of corn and diverticulitis or
between nut, popcorn, or corn consumption and diverticular bleeding or
uncomplicated diverticulosis.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
11
Physical Activity
It is unclear if lack of vigorous exercise is a risk factor for diverticular
disease. However, vigorous physical activity appears to reduce the risk of
diverticulitis and diverticular bleeding.
Obesity
Obesity has been associated with an increase in risk of both diverticulitis and
diverticular bleeding.
Other
Current smokers appear to be at increased risk for perforated diverticulitis
and a diverticular abscess as compared with nonsmokers. Caffeine and
alcohol are not associated with an increased risk for symptomatic diverticular
disease.
Several medications are associated with an increased risk of diverticulitis
and diverticular bleeding including nonsteroidal anti-inflammatory drugs,
steroids, and opiate. In contrast, statins may be associated with a decreased
risk of diverticular perforation. In addition, higher levels of vitamin D have
been associated with a reduced risk of hospitalization for diverticulitis.
Diagnosis Of Diverticular Disease
Based on symptoms and severity of illness, a person may be evaluated and
diagnosed by a primary care physician, an emergency department physician,
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
12
a surgeon, or a gastroenterologist. The health care provider will ask about
the person’s health, symptoms, bowel habits, diet, and medications, and will
perform a physical exam, which may include a rectal exam. A rectal exam is
performed in the health care provider’s office. To perform the exam, the
health care provider asks the person to bend over a table or lie on one side
while holding the knees close to the chest. The health care provider slides a
gloved, lubricated finger into the rectum. The exam is used to check for
pain, bleeding, or a blockage in the intestine.
The health care provider may schedule one or more of the following tests
outlined below.

Blood test:
A blood test involves drawing a person’s blood at a health care
provider’s office, a commercial facility, or a hospital and sending the
sample to a lab for analysis. The hemoglobin and complete blood count
(CBC) blood test can show the presence of inflammation or anemia —
a condition in which red blood cells are fewer or smaller than normal,
which prevents the body’s cells from getting enough oxygen.

Computerized tomography (CT) scan:
A CT scan of the colon is the most common test used to diagnose
diverticular disease. CT scans use a combination of X-rays and
computer technology to create three-dimensional (3–D) images. For a
CT scan, the person may be given a solution to drink and an injection
of a special dye, called contrast medium. CT scans require the person
to lie on a table that slides into a tunnel-shaped device where the
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
13
X-rays are taken. The procedure is performed in an outpatient center
or a hospital by an X-ray technician, and a radiologist interprets the
images. Anesthesia is not needed. CT scans can detect diverticulosis
and confirm the diagnosis of diverticulitis.

Lower gastrointestinal (GI) series:
A lower GI series is an x-ray exam that is used to look at the large
intestine. The test is performed at a hospital or an outpatient center by
an x-ray technician, and a radiologist interprets the images.
Anesthesia is not needed.
The health care provider may provide written bowel prep instructions
to follow at home before the test. The person may be asked to follow a
clear liquid diet for one to three days before the procedure. A laxative
or enema may be used before the test. A laxative is medication that
loosens stool and increases bowel movements. An enema involves
flushing water or laxative into the rectum using a special squirt bottle.
These medications cause diarrhea, so the person should stay close to a
bathroom during the bowel prep.
For the test, the person will lie on a table while the radiologist inserts a
flexible tube into the person’s anus. The colon is filled with barium,
making signs of diverticular disease show up more clearly on X-rays.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
14
For several days, traces of barium in the large intestine can cause
stools to be white or light colored. Enemas and repeated bowel
movements may cause anal soreness. A health care provider will
provide specific instructions about eating and drinking after the test.

Colonoscopy:
This test is performed at a hospital or an outpatient center by a
gastroenterologist. Before the test, the person’s health care provider
will provide written bowel prep instructions to follow at home. The
person may need to follow a clear liquid diet for one to three days
before the test. The person may also need to take laxatives and
enemas the evening before the test.
In most cases, light anesthesia, and possibly pain medication, will help
a patient relax for the test. The patient lies on a table while the
gastroenterologist inserts a flexible tube into the anus. A small camera
on the tube sends a video image of the intestinal lining to a computer
screen. The test can show diverticulosis and diverticular disease.
Cramping or bloating may occur during the first hour after the test.
Driving is not permitted for 24 hours after the test to give the
anesthesia time to wear off. Before the appointment, a patient should
make plans for a ride home. Full recovery is expected by the next day,
and people should be able to go back to their normal diet.1
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
15
Complications Of Diverticular Disease
About 25 percent of people with acute diverticulitis develop complications,
which may include:2

An abscess, which occurs when pus collects in the pouch

A perforation, a small tear or hole in the diverticula

A blockage in the colon or small intestine caused by scarring

An abnormal passageway (fistula) between sections of bowel or the
bowel and bladder

Peritonitis, a medical emergency that requires immediate care,
which can occur if the infected or inflamed pouch ruptures, spilling
intestinal contents into the abdominal cavity
Abscess, Perforation, and Peritonitis
Antibiotic treatment of diverticulitis usually prevents or treats an abscess. If
the abscess is large or does not clear up with antibiotics, it may need to be
drained. After giving the person numbing medication, a radiologist inserts a
needle through the skin to the abscess and then drains the fluid through a
catheter. An abdominal ultrasound or a CT scan usually is done prior to
deciding the procedure.
A person with a perforation usually needs surgery to repair the tear or hole.
Sometimes, a person needs surgery to remove a small part of the intestine if
the perforation cannot be repaired.
A person with peritonitis may be extremely ill, with nausea, vomiting, fever,
and severe abdominal tenderness. This condition requires immediate surgery
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
16
to clean the abdominal cavity and possibly a colon resection at a later date
after a course of antibiotics. A blood transfusion may be needed if the person
has lost a significant amount of blood. Without prompt treatment, peritonitis
can be fatal.1
Fistula
Diverticulitis-related infection may lead to one or more fistulas. Fistulas
usually form between the colon and the bladder, small intestine, or skin. The
most common type of fistula occurs between the colon and the bladder.
Fistulas can be corrected with a colon resection and removal of the fistula.
Intestinal Obstruction
Diverticulitis-related inflammation or scarring caused by past inflammation
may lead to intestinal obstruction. If the intestine is completely blocked,
emergency surgery is necessary, with possible colon resection. Partial
blockage is not an emergency, so the surgery or other procedures to correct
it can be scheduled.
When urgent surgery with colon resection is necessary for diverticulitis, two
procedures may be needed because it is not safe to rejoin the colon right
away. During the colon resection, the surgeon performs a temporary
colostomy, creating an opening, or stoma, in the abdomen. The end of the
colon is connected to the opening to allow normal eating while healing
occurs. Stool is collected in a pouch attached to the stoma on the abdominal
wall. In the second surgery, several months later, the surgeon rejoins the
ends of the colon and closes the stoma.1
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
17
Treatment Of Diverticular Disease
People with diverticulosis who do not have symptoms do not require
treatment. However, most clinicians recommend increasing fiber in the diet,
which can help to bulk the stools and possibly prevent the development of
new diverticula, diverticulitis, or diverticular bleeding. Fiber is not proven to
prevent these conditions in all patients but may help to control recurrent
episodes in some.3,4
Fiber
Increased fiber is recommended in the treatment of diverticular disease.
Fruits and vegetables are a good source of fiber.
Seeds and Nuts
Patients with diverticular disease have historically been advised to avoid
whole pieces of fiber (such as seeds, corn, and nuts) because of concern
that these foods could cause an episode of diverticulitis. However, this belief
is completely unproven. Current recommendations do not suggest that
patients with diverticulosis avoid seeds, corn, or nuts.
Medications
A number of studies suggest the medication mesalazine (Asacol), given
either continuously or in cycles, may be effective at reducing abdominal pain
and GI symptoms of diverticulosis. Research has also shown that combining
mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
18
effective than using rifaximin alone to improve a person’s symptoms and
maintain periods of remission.1
Probiotics
Although more research is needed, probiotics may help treat the symptoms
of diverticulosis, prevent the onset of diverticulitis, and reduce the chance of
recurrent symptoms. Probiotics are live bacteria, like those normally found in
the GI tract. Probiotics can be found in dietary supplements — in capsules,
tablets, and powders — and in some foods, such as yogurt.1
Diverticulitis
Diverticulitis treatment depends upon the severity of the symptoms.
Home treatment
Mild symptoms of diverticulitis (mild abdominal pain, usually left lower
abdomen), can be treated at home with a clear liquid diet and oral
antibiotics. However, if one or more of the following signs or symptoms
develop, one should seek immediate medical attention:

Temperature >100.1°F (38°C)

Worsening or severe abdominal pain

An inability to tolerate fluids
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
19
Hospital treatment
Moderate to severe symptoms, may require hospitalization for treatment.
During this time, the patient will not be allowed to eat or drink; IV fluids and
antibiotics will be administered.
If a colon abscess develops, the patient may need to have the abscess
drained. This is usually performed by placing a drainage tube across the
abdominal wall or by surgically opening the affected area.
Surgery
If a generalized infection in the abdomen develops, (peritonitis), an
emergency operation is usually required. A two-part operation may be
necessary in some cases.
The first operation involves removal of the diseased colon and creation of a
colostomy. A colostomy is an opening between the colon and the skin, where
a bag is attached to collect waste from the intestine. The lower end of the
colon is temporarily sewed closed to allow it to heal.
Approximately three to six months later, a second operation is performed to
reconnect the two parts of the colon and close the opening in the skin. The
patient will then be able to empty the bowel through the rectum. Sometimes
patients require up to a year to recover from the first operation, depending
on how sick they were.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
20
In non-emergency situations, the diseased area of the colon can be removed
and the two ends of the colon can be reconnected in one operation, without
the need for a colostomy.
An operation to remove the diseased area of the colon may not be necessary
if the patient improves with medical therapy. However, people who are
treated with an operation are felt to be cured, since only 15 percent of
people develop further diverticulosis after surgery and only 2 to 11 percent
of people need further surgery.4 Thus, surgery may be recommended for
people with repeated attacks of diverticulitis or if there are severe or
repeated episodes of bleeding. The decision depends in part upon other
medical conditions and ability to undergo surgery.
Some healthcare providers recommend surgery after the first attack of
diverticulitis in people who are less than 40 to 50 years. The reason for this
is that the disease may be more severe in this age group and there may be
an increased risk of recurrent disease that will ultimately require surgery.
Thus, having surgery at a young age could potentially eliminate the chances
of developing worsened disease.4
In many cases, an elective operation can be performed laparoscopically,
using small incisions, rather than the typical vertical abdominal incision.
Laparoscopic surgery usually allows for a faster recovery and a shorter
hospital stay.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
21
Diverticular Bleeding
Diverticular bleeding is rare. Bleeding can be severe; however, it may stop
by itself and not require treatment. A person who has bleeding from the
rectum, even a small amount, should see a health care provider right away.
To treat the bleeding, a colonoscopy may be performed to identify the
location of and stop the bleeding. A CT scan or angiogram also may be used
to identify the site of the bleeding. A traditional angiogram is a special kind
of X-ray in which a thin, flexible tube called a catheter is threaded through a
large artery, often from the groin, to the area of bleeding. Contrast medium
is injected through the catheter so the artery shows up more clearly on the
X-ray. The procedure is performed in a hospital or an outpatient center by
an X-ray technician, and a radiologist interprets the images. Anesthesia is
not needed, though a sedative may be given to lessen anxiety during the
procedure.
If the bleeding does not stop, abdominal surgery with a colon resection may
be necessary. In a colon resection, the surgeon removes the affected part of
the colon and joins the remaining ends of the colon together; general
anesthesia is used. A blood transfusion may be needed if the person has lost
a significant amount of blood.1
Prognosis Of Diverticular Disease
Diverticulosis
Over time, diverticulosis may cause no problem or it may cause episodes of
bleeding and/or diverticulitis. Approximately 15 to 25 percent of people with
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
22
diverticulosis will develop diverticulitis, while 5 to 15 percent will develop
diverticular bleeding.
Diverticulitis
Approximately 85 percent of people with uncomplicated diverticulitis will
respond to medical treatment, while approximately 15 percent of patients
will need an operation. After successful treatment for a first attack of
diverticulitis, one-third of patients will remain asymptomatic, one-third will
have episodic cramps without diverticulitis, and one-third will go on to have
a second attack of diverticulitis.
The prognosis tends to remain similar following a second attack of
diverticulitis. Only 10 percent of people remain symptom-free after a second
attack. Subsequent attacks tend to be of similar severity, not increasing in
severity as previously believed.4
Prevention Of Diverticular Disease
To prevent diverticular disease or reduce the complications from it, it is
important to maintain good bowel habits. This includes having regular bowel
movements and avoiding constipation and straining. Eating appropriate
amounts of the right types of fiber and drinking plenty of water and
exercising regularly will help keep bowels regulated.
The American Dietetic Association recommends 20 to 35 grams of fiber a
day. Every person, regardless of the presence of diverticula, should try to
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
23
consume 20 to 35 grams of fiber every day. Fiber is the indigestible part of
plant foods. High-fiber foods include whole grain breads, cereals, and
crackers, berries, fruit, vegetables (such as broccoli, cabbage, spinach,
carrots, asparagus, squash, and beans), brown rice, bran products, and
cooked dried peas and beans, among other foods. Drinking eight 8-ounce
glasses of water a day, monitoring changes in bowel movements (from
constipation to diarrhea) and getting enough rest and sleep, are other ways
to prevent diverticular disease.2
Summary
In summary, diverticular disease consists of three conditions that involve the
development of small sacs or pockets in the wall of the colon diverticulum)
including diverticulosis, diverticular bleeding, and diverticulitis. This course
has discussed these conditions, as well as their symptoms, causes, risk
factors, diagnosis, complications and treatment.
Please take time to help NurseCe4Less.com course planners evaluate
the nursing knowledge needs met by completing the self-assessment
of Knowledge Questions after reading the article, and providing
feedback in the online course evaluation.
Completing the study questions is optional and is NOT a course
requirement.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
24
1.
Diverticulosis specifically describes
a. the presence of diverticula with symptoms.
b. the presence of diverticula.
c. the presence of diverticula with diverticular bleeding.
d. inflammation of a diverticulum.
2.
Inflammation of a diverticulum, known as ____________ occurs
when there is thinning and breakdown of the diverticular wall.
a. diverticulosis
b. colitis
c. diverticulitis
d. diverticular bleeding
3.
A fistula is
a. a localized collection of pus.
b. an abnormal tract between two areas that are not normally
connected.
c. a blockage of the colon.
d. an infection around the abdominal organ.
4.
Sepsis is defined as
a. an abnormal tract between two areas that are not normally
connected.
b. an infection around the abdominal organ.
c. a blockage of the colon.
d. an overwhelming body-wide infection.
5.
Diverticular bleeding occurs
a. when a small artery in a diverticulum erodes and bleeds into the
colon.
b. in 25% of cases of simple diverticulitis.
c. in 75 percent of all cases of diverticulitis.
d. in all of the above.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
25
6.
True or False: A recent study found that a low-fiber diet was
associated with diverticulosis and an increased chance of
diverticula.
a. True.
b. False.
7.
In the colon, inflammation may be caused by
________________________.
a. a decrease in healthy bacteria.
b. a decrease in disease-causing bacteria.
c. an increase in disease-causing bacteria.
d. both a and c.
8.
____________ has been associated with an increase in risk of
both diverticulitis and diverticular bleeding.
a. A low-fiber diet
b. Lack of exercise
c. Obesity
d. Corn or popcorn consumption
9.
____________ appears to increase the risk for perforated
diverticulitis and a diverticular abscess.
a. Smoking
b. Consuming caffeine
c. Alcohol consumption
d. Inactivity
10. In testing for diverticular disease, a blood test may be ordered
by the healthcare provider to determine
a. the presence of diverticula.
b. the level of healthy bacteria.
c. the presence of inflammation or anemia.
d. levels of blood-alcohol.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
26
11. Which of the following is the most common test used to
diagnose diverticular disease?
a. Flexible sigmoidoscopy
b. Computerized tomography (“CT”) scan of the colon
c. Lower gastrointestinal (“GI”) series
d. Colonoscopy
12. For several days, the patient’s stools may be white or lightcolored after which procedure?
a. Lower gastrointestinal (“GI”) series
b. Colonoscopy
c. CT scan of the colon
d. Enema.
13. ______________________ is/are associated with an increased
risk of diverticulitis and diverticular bleeding.
a. Statins
b. Higher levels of vitamin D
c. Alcohol consumption
d. Steroids
14. One complication of acute diverticulitis may be
________________, which involves spilling intestinal contents
into the abdominal cavity.
a. peritonitis
b. sepsis
c. a fistula
d. colitis
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
27
15. The usual treatment for a patient with diverticulitis who
develops an abscess is
a. to drain the abscess.
b. to surgically remove the abscess.
c. to remove a small part of the intestine.
d. to treat the patient with antibiotics.
16. Which of the following is true of diverticular bleeding?
a. It is common for patients with diverticulitis.
b. It may stop by itself and not require treatment.
c. Bleeding is never severe.
d. A patient need only see a healthcare provider if the bleeding is
severe.
17. The American Dietetic Association recommends __________
grams of fiber a day.
a. more than 50
b. 20 to 35
c. 10
d. 40 to 50
18. An procedure called __________________________ uses small
incisions, rather than the typical vertical abdominal incision, to
treat diverticulitis.
a. an angiogram
b. flexible sigmoidoscopy
c. laparoscopic surgery
d. a colostomy
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
28
19. Diverticular disease generally involves the presence of
_________________ in the wall of the colon.
a. disease-causing bacteria
b. bleeding
c. small sacs or pockets
d. an abscess
20. True or False: When treating diverticulosis, combining
mesalazine with the antibiotic rifaximin (Xifaxan) can be
significantly more effective than using rifaximin alone.
a. True
b. False
References Section
The reference section of in-text citations include published works intended as
helpful material for further reading. Unpublished works and personal
communications are not included in this section, although may appear within
the study text.
1.
2.
3.
4.
Diverticular Disease (2013) National Institute of Diabetes and Digestive
and Kidney Diseases. Retrieved December 28, 2015 from
www.niddk.nih.gov
Diverticulitis (2014) Mayo Foundation for Medical Education and
Research. Retrieved December 18, 2015 from www.mayoclinic.org
Pemberton, J.H. & Young-Fadok, T. (2015) Clinical manifestations and
diagnosis of acute diverticulitis in adults, in Lamont, J.T. (Ed.),
UpToDate. Waltham, Mass.: UpToDate. Retrieved December 19, 2015
from www.uptodate.com
Young-Fadok, T. & Pemberton, J.H. (2015) Colonic diverticulosis and
diverticular disease: Epidemiology, risk factors, and pathogenesis, in
Friedman, L.S. (Ed.), UpToDate. Waltham, Mass.: UpToDate. Retrieved
December 19, 2015 from www.uptodate.com
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com
29
The information presented in this course is intended solely for the use of healthcare professionals taking
this course, for credit, from NurseCe4Less.com. The information is designed to assist healthcare
professionals, including nurses, in addressing issues associated with healthcare.
The information provided in this course is general in nature, and is not designed to address any specific
situation. This publication in no way absolves facilities of their responsibility for the appropriate
orientation of healthcare professionals.
Hospitals or other organizations using this publication as a part of their own orientation processes
should review the contents of this publication to ensure accuracy and compliance before using this
publication.
Hospitals and facilities that use this publication agree to defend and indemnify, and shall hold
NurseCe4Less.com, including its parent(s), subsidiaries, affiliates, officers/directors, and employees from
liability resulting from the use of this publication.
The contents of this publication may not be reproduced without written permission from
NurseCe4Less.com.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com