DIVERTICULAR DISEASE

Diverticula

◦ Diverticula is a saclike herniation of the lining of the bowel that extends through a defect in a

muscle layer.

Diverticulosis

Diverticulosis exists when multiple diverticula are present without inflammation or symptoms. Most

patients with diverticula the disease are asymptomatic, so it's exact prevalence is unknown.

Diverticulitis

◦ Diverticulitis results when food and bacteria retained in a diverticulum produce infection and

inflammation that can impede drainage and lead to perforation or abscess formation.

Pathophysiology

◦ Diverticula form when the mucosa and submucosal layers of the colon herniate through the

muscular wall because of high intraluminal pressure, low volume in the colon, and decreased muscle

strength in the colon wall. ◦ Bowel contents can accumulate in the diverticulum and decompose,

causing inflammation and infection. ◦ The diverticulum can also become obstructed and then inflamed

if the obstruction continues. ◦ The inflammation of the weakened colonic wall of the diverticulum can

cause it to perforate, giving rise to irritability and spasticity of the colon.

Clinical Manifestations

◦ Chronic constipation often precedes the development of diverticulosis by many years. ◦ No

problematic symptoms occur with diverticulosis. ◦ Signs and symptoms are relatively mild and

include bowel irregularity with intervals of diarrhea, nausea and anorexia, and bloating of abdominal

distention. ◦ Weakness, fatigue, and anorexia are common symptoms. ◦ With diverticulitis, the patient
reports an acute onset of mild to severe pain in the lower left quadrant, accompanied by nausea,

vomiting, fever, chills, and leukocytosis.

Diagnostic Procedure

◦ Colonoscopy – permits visualization of the extent of diverticular disease and allows the physician to

biopsy tissue to rule out other diseases. ◦ Barium Enema – used frequently nowadays than

colonoscopy. ◦ CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is

diverticulitis; it can also reveal abscesses. ◦ Abdominal x-rays may demonstrate free air under the

diaphragm if a perforation has occurred from diverticulitis. ◦ Laboratory tests that assists in diagnosis

include a complete blood cell count, revealing an elevated WBC count and elevated erythrocyte

sedimentation rate (ESR).

Gerontologic Considerations

◦ The incidence of diverticular disease increases with age because of degeneration and structural

changes in the circular muscle layers of the colon and because of cellular hypertrophy. ◦ The elderly

may not have abdominal pain until infection occurs. ◦ Elders may delay reporting symptoms because

they fear surgery or are afraid that they may have cancer. ◦ Blood is overlooked frequently because of

inability to see changes if vision is impaired.