Diverticulosis and Diverticulitis
Diverticulosis or diverticular disease is the condition of having diverticula in the colon (Wilkins,
Embry & George, 2015). Diverticulitis is inflammation of the diverticula. Diverticulitis can occur in the
small and large intestine or the colon. It can occur at any age when diverticula are present. About
95% of the patients suffer from diverticulitis found in the sigmoid colon (Wilkins, Embry & George,
2015).
Signs and Symptoms
Patients with diverticulitis may present with fever, malaise, fatigue, nausea and vomiting,
diarrhea, and dysuria, tachycardia, hypotension and constant left lower quadrant pain (LLQ) (Wilkins,
Embry & George, 2015). Patients may have a history of diverticulosis or diverticulitis. The physical
exam may reveal tenderness in the LLQ, abdominal distension and/or a palpable mass (Wilkins,
Embry & George, 2015).
Pathophysiology
The existing concept in which dietary fiber is a protective factor against the formation of
diverticula and consequent diverticulitis (Buttaro, Trybulski, Bailey & Sandberg-Cook, 2015). Low
fiber diets reduce the amount of intraluminal bulk in the colon, causing muscle hypertrophy as the
colon tries to push the bowel matter along. Over time, the wall of the colon is placed under frequent
straining and ultimately, the submucosa and mucosa punch through the weakened muscular layer to
form thin-walled sacs or diverticula. Diverticulitis occurs when diverticular sac can become inflamed
and infected because undigested food deposits and bacteria get trapped in diverticular sacs. If
diverticulitis occurs, bacterial invasion arises, and blood supply is mechanically compromised. If
untreated, diverticulitis can progress to peritonitis, perforation, sepsis and life-threatening (Buttaro,
Trybulski, Bailey & Sandberg-Cook, 2015).
Three differential diagnoses
Bowel obstruction
: Diverticulitis can prevent the passage of stool and cause a blockage in the
intestine which leads to a bowel obstruction (Welbourn & Hartley, 2015). Patient may present with
bloating, abdominal pain and distention, thin stools, diarrhea and constipation, nausea and vomiting
(Welbourn & Hartley, 2014).
Ulcerative colitis (UC
): Ulcerative colitis is disease of the colon characterized by chronic
inflammation (Adams & Bornemann, 2015). Patients with UC typically presents with fatigue, low
grade fever, diarrhea with pus, mucus or blood and abdominal pain which can be sudden or gradual
(Adams & Bornemann, 2015).
Bacterial gastroenteritis:
Bacterial gastroenteritis occurs when bacteria causes an
inflammatory infection in colon (Barrett & Fhogartaigh, 2017). Patients with bacterial gastroenteritis
may experience symptoms such as mild to severe abdominal cramping, diarrhea, blood in stools,
fever, nausea and vomiting (Barrett & Fhogartaigh, 2017).
Treatment
With an acute diverticulitis attack, hospitalization is suggested for immunocompromised or diabetic
patients (Buttaro, Trybulski, Bailey & Sandberg-Cook, 2015). Patients should immediately stop
drinking/eating to prevent further strain on the inflamed colon. Hospital management consists of
