Diverticulosis and Diverticulitis Pathophysiology

1. Compare and contrast the pathophysiology of diverticular disease (diverticulosis) and acute diverticulitis. (CO1) 2. Identify risk factors for acute diverticulitis and the clinical signs and symptoms associated with the disease. (CO3) 3. Explain the significance of physical exam and diagnostic findings in the diagnosis of diverticular disease. (CO4) Requirements: 1. Read the case study below. 2. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT. Case Scenario: An 84- year-old -female who has a history of diverticular disease presents to the clinic with left lower quadrant (LLQ) pain of the abdomen that is accompanied by with constipation, nausea, vomiting and a low-grade fever (100.20 F) for 1 day. On physical exam the patient appears unwell. She has signs of dehydration (pale mucosa, poor skin turgor with mild hypotension [90/60 mm Hg] and tachycardia [101 bpm]). The remainder of her exam is normal except for her abdomen where the NP notes a distended, round contour. Bowel sounds a faint and very hypoactive. She is tender to light palpation of the LLQ but without rebound tenderness. There is hyper-resonance of her abdomen to percussion.   The following diagnostics reveal:   Stool for occult blood is positive. Flat plate abdominal x-ray demonstrates a bowel-gas pattern consistent with an ileus.  Abdominal CT scan with contrast shows no evidence of a mass or abscess. Small bowel in distended.  Based on the clinical presentation, physical exam and diagnostic findings, the patient is diagnosed with acute diverticulitis and she is admitted to the hospital. She is prescribed intravenous antibiotics and fluids (IVF). Her symptoms improved and she could tolerate a regular diet before she was discharged to home.    Discussion Questions: 1. Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis. 2. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.   3. List 3 risk factors for acute diverticulitis. 4. Discuss why antibiotics and IV fluids are indicated in this case.

Answer

Diverticulitis Pathophysiology

Diseases can present with similar symptoms, and a comprehensive assessment and history-taking can help with a definite diagnosis and effective treatment. The clinical presentations of a disease and imaging studies help care providers with diagnosis and management. Nurses assess patients and gather all objective and subjective data to aid in patient management. This essay analyzes the clinical presentation of an 83-year-old female with a history of diverticular disease.

Diverticulosis and Diverticulitis Pathophysiology

The pathophysiology of diverticulosis and diverticulitis are quite incompletely understood, with various etiologies such as constipation and low fiber diet. Diverticulosis or diverticular disease is a condition in which the intestines develop pouches or folds. The disease can be chronic because it does not cause symptoms, and it is estimated that more than 70% of individuals above 40 years have the condition. Diverticulitis is the inflammation of these pouches (diverticular), and etiologies include bacterial infections in which fecal matter with bacteria enters these pouches (Schieffer et al., 2018). Diverticulitis is a clinically significant condition that can affect the quality of life and presents with abdominal cramping, pain, blood in stool, and bowel habit changes. In some patients, the symptoms may be severe and do not respond to treatment.

Clinical Findings

The patient has a history of diverticular disease. The patient presents to the clinic with lower left quadrant abdominal pain accompanied by nausea, vomiting, constipation, and a low-grade fever. According to Schieffer et al. (2018), diverticular is often harmless and presents with no pain, unlike diverticulitis. The patient also has dehydration signs from skin paleness, turgor, and low blood pressure. Further assessment reveals occult blood, and imaging studies show bowel gas and small intestines distention. In addition, her abdomen is hyper-resonant to percussion, and the bowel sounds are faint.

Risk Factors for the Diverticulitis

Various risk factors include diverticulitis aging (risk increases with age), obesity, a diet with high animal fat and low fiber content, constipation, smoking, and medications such as non-steroidal anti-inflammatory drugs (Alessandra et al., 2018). Maguire (2020) shows that individuals have a 40-53% genetic predisposition to the disease. These factors do not cause the disease but increase the chances of contracting the disease. When not treated, the condition could lead to bleeding, colon blockage, peritonitis, and colon perforation.

Antibiotics and IV Fluids Use in Diverticulitis

Antibiotics and IV fluids are some of the interventions necessary for this patient. Acute diverticulitis is the inflammation of a diverticulum, as discussed earlier. They follow a diverticular disease, and bacteria infection is the primary cause of inflammation. Antibiotics are used to clear the bacteria infection. In addition, an inflamed mucous membrane means the first-line defense against microorganisms is broken; thus, individuals are exposed to infections from the normal flora. Thus, antibiotics treat any infections and serve as prophylaxis to prevent infection. For this patient, IV fluids are indicated. The patient is sick looking, and the physical examination reveals a pale mucosa, mild hypotension, constipation, and poor skin turgor. The history reveals that the patient is vomiting: a primary cause of dehydration that should be corrected. IV fluids are necessary for this patient to ensure adequate hydration, prevent hypovolemic hypertension, and eliminate constipation.

Conclusion

Their clinical presentations and etiologies help differentiate diverticulosis from diverticulitis. Diverticulosis is a harmless disease, but inflammation may lead to severe complications when not adequately managed. Diverticulitis management involves antibiotics and fluids to manage infection and dehydration. Accurate diagnosis leads to definitive treatment and better patient outcome.

References

Alessandra, V., Ginevra, C., Chiara, M., Alberto, B., Antonio, N., Mario, C., Gioacchino, L., Tiziana, M., Gian, L. A., & Francesco, D. M. (2018). Epidemiology and risk factors for diverticular disease. Acta Bio Medica: Atenei Parmensis89(Suppl 9), 107. https://doi.org/10.23750/abm.v89i9-S.7924

Maguire, L. H. (2020). Genetic Risk Factors for Diverticular Disease—Emerging Evidence. Journal of Gastrointestinal Surgery24(10), 2314-2317. https://doi.org/10.1007/s11605-020-04693-5

Schieffer, K. M., Kline, B. P., Yochum, G. S., & Koltun, W. A. (2018). Pathophysiology of diverticular disease. Expert Review of Gastroenterology & Hepatology, 12(7), 683-692. https://doi.org/10.1080/17474124.2018.1481746

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