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Diverticular Disease DIVERTICULAR DISEASE NOAH CARPENTER, MD Dr. Noah Carpenter is a Thoracic and Peripheral Vascular Surgeon. He completed the Bachelor of Science in chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of the Native Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, the Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education. Abstract Diverticulosis is a common condition in Western countries and carries the risk of serious complications. Inflammation and infection of the colon are characteristic of the complication of diverticulitis. Typically, ultrasound and computed tomography imaging is used in cases of of diverticulitis to help clinicians identify edematous thickening of the bowel wall and inflammatory changes. While uncomplicated diverticulitis can be treated through medical management, surgical intervention may be needed in complicated diverticulitis and without surgical intervention the prognosis may be grave. Diverticular disease and its complications including the life-threatening event of a bowel perforation are discussed. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.co M 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 2.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology 0.5 hours (30 minutes). 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 clinicians with knowledge to care for patients with diverticular disease. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.co M 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 Noah Carpenter, MD, 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. 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. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.co M 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 when a small artery in a diverticulum a. erodes and bleeds into the colon. b. is obstructed. c. abscesses. d. forms a fistula. 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.co M Introduction Diverticulosis of the colon is a common disease in Western countries. Many of the cases reported exclude asymptomatic or uncomplicated diverticulosis. Much of the medical literature focuses on the complications of diverticulosis although the majority of cases pertain to uncomplicated diverticulosis. Complicated diverticulosis of the colon receives much attention in the health literature because it is an important cause of hospital admissions and significant economic burden of the health system in the United States. Diverticular disease consists of three main conditions that involve the development of small sacs or pockets in the wall of the colon (diverticulum) including diverticulosis, diverticular bleeding, and diverticulitis (infection). The diagnosis, complications and treatment of diverticulosis are discussed in the following sections in addition to a key focus on the effect of lifestyles factors such as diet and weight on the prevalence of diverticulosis and risk of hospitalization. Prevalence and Etiology Diverticular disease has been defined as clinically significant and symptomatic diverticulosis due to diverticular bleeding, diverticulitis, segmental colitis associated with diverticula, or symptomatic uncomplicated diverticular disease. In Western countries there is a higher prevalence of diverticulosis with as high as 60% of individuals over 70 years of age being affected.1 Diverticulosis has been reported to increase with age. The incidence in younger individuals (less than age 45) for acute diverticulitis is 16 percent. Asymptomatic (diverticulosis) occurs in a majority of individuals and approximately 20% have symptomatic uncomplicated diverticular disease 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.co M (SUDD) with recurring symptoms such as abdominal pain, bloating, changes in bowel patterns. SUDD may mimic symptoms of irritable bowel syndrome (IBS) and clinicians performing an abdominal evaluation would want to look for specific abdominal pain features that include “pain localisation, pain relief by defecation or flatulence, and pain duration…”1 Complications will occur in approximately 4% of patients, and may include acute diverticulitis, which is relatively lower an incidence as compared to the general population rate of diverticulosis. 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, and diverticular bleeding.1 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 weakness, dizziness or lightheadedness, and abdominal cramping.1 Medical researchers are not certain what causes diverticulosis and diverticular disease. For more than 50 years, the most widely accepted theory was that a low-fiber 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. 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.co M 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 anti- inflammatory
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