NR 507 Week 5 Discussion

Sample Answer

Diverticula, the marble size out pouching of the colon, has a prevalence rate of between 42% and 60% in the United States with a mean age of 55 years old (Kaise et al., 2019). The report noted that nearly 80% of cases developed between the descending and the sigmoid colon. Kaise et al. noted conversely, that in Asian countries, prevalence of diverticula is lower overall and when present most often originates between the cecum and the ascending colon (2019). The article noted that colonic diverticular bleeding is a leading cause of mortality in the elderly with co-morbidities.

Nearly 25% of patients with colonic diverticula develop symptoms (Barbaro et al., 2022). The article noted that most often these symptoms occur without inflammation and are termed uncomplicated diverticular disease or diverticulosis. Barbara et al. noted that the pathophysiology of diverticulosis involved both epigenetic and microbiota changes (2022). The article noted that diverticulitis occurs in 1% of patients with colonic diverticular disease. Diverticulitis develops when the diverticulum is obstructed by fecal matter leading to inflammation (Barbaro et al., 2022).

With diverticulosis, the injury is often more localized to affected diverticulum segment versus the inflammation of diverticulum and adjacent areas seen with diverticulitis (Kruis et al., 2022). Per this article, the most common complications of diverticulitis including bleeding, perforation, fistulas and abscesses which can occur in patterns of remission and relapse. Kruis et al, noted that physical examination, laboratory testing and CT scans help differentiate between diverticulosis and diverticulitis (2022).

With our case scenario, we have an elderly patient with a history of diverticular disease relapse. Clinical findings of acute diverticulitis include the symptoms of malaise, positive occult blood, low grade fever, and vomiting. Risk factors for diverticulitis include advancing age, a BMI >30, sedentary lifestyles and a diet low in fiber (Lukosiene et al, 2021). The article also noted that other risk factors included increased bowel frequency and tenesmus. Lukosiene et al. noted that sex difference, NSAID use, smoking, and alcohol consumption were not associated with increased risk (2021). Our case involved an elderly female. No data was provided on weigh, height, activity level, nor diet.

A review of five random control trial studies found treatment of uncomplicated diverticulitis with or without antibiotics to have similar outcomes while the rate of emergency surgery within 30 days of treatment was lower when no antibiotic was administered (Dichman et al., 2022). Our case study involved a complicated diverticulitis due to hemorrhage. Antibiotics are therefore recommended and required. IV fluids are indicated because of signs of dehydration and compromised health status.

References

• Barbaro, M., Cremon, C., Fischi, D., Marasco, G., Palmobo, M., Stanghellini, V. & Barbara, G. (2022). Pathophysiology of diverticular disease from diverticular formation to symptom generation. Internal Journal of Molecular Science, 23(12), 6698. DOI 10.3390/ ijms23126698
• Dichman, M. L., Rsenstaock, S. & Shabanzadeh, D. (2022). Antibiotics for uncomplicated diverticulitis. Cochrane Library, 2022(6). https //doi.org/Links to an external site. 10.1002/14651858.CD009092.pub3
• Kaise, M., Negate, N.,Ishii, N., Omari, J., Goto, O. & Iwakiri, K., (2019). Epidemiology of conic diverticula and recent advances in the management of colonic diverticular bleeding. Digestive Endoscopy, 32(2), 240 – 250. https //doi-Links to an external site. org.chamberlainuniversity.idm.oclc.org/10/1111/den.13547Links to an external site.
• Kruis, W., Germer, C.T., Bohm, S., Dumoulin, F., Frieling, T., Hampe, J., Keller, J., Freis, M., Meining, A., Labenz, J., Lock, J., Ritz, J. Schreyer, A. & Leifeld, L. (2022). German guidline diverticular disease/diverticulitis. United European Gastroenterol Journal, 10(9), 923 – 939. DOI 10.1002/ueg2.12309
• Lukosiene, J., Reichert, M., Lammert, F., Schramm, C., Greser, T., Kiudelis, G., Jonaitis, L., Tamelis, A. & Kupcinskas, J. (2021). Enviornmental and dietary risk factors for colonic diverticulosis and diverticulitis. Journal of Gastrointestinal & Liver Diseases. 30(1), 66 – 72. DOI https //dx.doi.org/10.15403/jgld-3208