Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.

Diverticulosis is diverticular disease without symptoms.  Diverticula are outpouchings, sac like areas in the mucosa that penetrate through the muscle layer into the intestinal wall.  The outpouchings are weakened areas in the intestinal wall, usually the colon, caused by a disease with an unknown etiology.  These sacs in the mucosal lining can be found anywhere on the gastrointestinal tract however, are more common in the left and right colon.  The mucosa in the colon wall herniates through the smooth muscle of the bowel.  With diverticulosis, individuals do not usually know they even have it unless found during a procedure.  The motility of the bowel continues until the intracolonic pressure builds to a point of causing problems. (Huether & McCrance, 2019)

Diverticulitis is where a patient that had diverticular disease that the outpouches have now become inflamed (“itis” on the end of a word is inflammation), irritated, and now the patient has symptoms.  Once the inflammation occurs, pain becomes associated and symptoms continue to worsen.  The inflamed areas, if left untreated, can continue to worsen to the point of causing an ileus of the bowel or a perforation with bleeding noted as a symptom. (Huether & McCrance, 2019)

Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.  

The clinical findings from this patient would be complaints of nausea, vomiting, constipation (common factor of diverticulitis), low grade fever, left lower quadrant abdominal pain (which the left colon is predominately where diverticulitis is seen), the CT scan showing the small bowel is distended and the flat plate abdominal x-ray presenting with a bowel-gas pattern for an ileus which was caused by the lack of motility in the bowel consistent with diverticulitis. (Huether & McCrance, 2019)

List 3 risk factors for acute diverticulitis.

Three risk factors that increase the chance of diverticulitis in an individual that has diverticulosis are obesity, lack of physical activity, older in age, constipation, and nonsteroidal antiinflammatory drug use. (Huether & McCrance, 2019)

Discuss why antibiotics and IV fluids are indicated in this case.

This patient needs IV fluids due to her nausea, vomiting, presenting to the clinic with pale mucosa, poor skin turgor, and mild hypotension symptoms confirming dehydration.  She also presented clinically with tachycardia, showing the body is attempting to compensate for fluid loss (volume depletion) increasing heart rate to circulate volume at a quicker rate through the system.  With the patient vomiting, a decrease in plasma volume occurs, in-turn increasing extracellular fluid volume leading to hypotension and eventually shock if left untreated.  With her low grade fever, dehydration will continue with her.  In addition, the protocol for treatment of diverticulitis is to rest the bowel which is her not eating or drinking for a few days making the patient unable to take fluids to provide for proper hydration. (Huether & McCrance, 2019) Considering the acute diverticulitis has already progressed to an ileus in the small bowel, resulting in distention of the ileum due to lack of motility in the colon backing up the content of the tract.  This decreases the small intestine’s ability to absorb electrolytes and water further increasing the secretion of these into the intestinal tract escalating the loss of absorption of these substances into the bloodstream. (Huether & McCrance, 2019)

According to the American Gastroenterological Association 2019 guidelines, for complicated diverticulitis including ileus, obstruction, or perforation, antibiotics via IV or oral if the patient can tolerate it are what is suggested.  This patient presenting with nausea and vomiting would not be able to consume by mouth antibiotics.  With the ileus being present, the food that is in the intestinal tract is unable to move through effectively which causes the bacteria that is already present in the intestinal tract to grow at an increased rate, causing the patient to become sicker quicker. (Agency for Healthcare Research and Quality, 2019) The inflammation that is already existent causes the immune system to naturally begin to react in the cell mediation chain to fight against the bacteria causing the infection and or inflammation.  The IV antibiotics can be on a short treatment coarse while the patient gives the intestinal tract a rest, taking nothing by mouth allowing the IV fluids to be absorbed in the system to rehydrate the patient and the antibiotics to treat the overgrowth of bacteria and inflammation of the diverticula. (Agency for Healthcare Research and Quality, 2019) If the bacteria in the colon goes untreated, gas continues to accumulate that is released from the bacteria in-turn causing additional distention and decreased intestinal tract motility which can cause perforation of the intestinal wall due to the increased intraluminal pressure. (Huether & McCrance, 2019)

References

Agency for Healthcare Research and Quality. (2019). Best practices in the diagnosis and treatment of diverticulitis and biliary tract infections [PDF]. AHRQ. Retrieved September 29, 2021, from https://www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/diverticulitis-biliary-infections-facilitator-guide.pdfLinks to an external site.