DIVERTICULOSIS

Chinasa Ekweariri
Dr. McGee
MNT II
FCSC 436
March 19, 2016
Case Study Project: Diverticulosis
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Case Study: Diverticulosis

Diverticulosis is the abnormal presence of outpockets, pouches, or sacs on the

surface of the small intestine or colon. Diverticulosis is most common in the adult, but

one form, Meckels diverticulum is present at birth. Meckels diverticula re usually found

near the ileocecal valve and may cause gastrointestinal bleeding or obstruction for the

newborn.

Estimations of prevalence or incidence are difficult because diverticulosis is

asymptomatic in most people. However, indicate diverticulosis is most common in

Western and industrialized countries, where it is thought that approximately 5-10% of the

population will have diverticula by age 50.

The development of diverticulosis was related to low fiber intake, history of

constipation, and the resulting long term increased colonic pressure. Recent

investigations have examined diverticular disease within the context of inflammation,

visceral hypersensitivity, microbiome changes, and abnormal motility. Obesity, decreased

physical activity, steroids, alcohol, caffeine intakes, and cigarette smoking have all been

found to be increasing risk factors of diverticulosis.

Diverticulosis is asymptomatic, which means producing or showing no

symptoms. Most adults are usually diagnosed when other tests such as a colonoscopy

identify them.

Diverticulosis is commonly found in the large intestine. Factors that affect

integrity of the mucosa of the colon appear to contribute to development of the

diverticula. Within the colon, two or more of the muscular bands contract at the same

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time. This hinders motility of he colon and thus its ability to move waste products. Fecal

matter becomes trapped and exerts excessive pressure against the wall of the colon. This

pressure causes development of small pouches on the wall of the colon, which are

referred to as diverticula.

Diverticulosis can only be treated through nutrition therapy. A diet with a specific

fiber amount is used to treat. The patient with diverticulosis is not at any more risk for

malnutrition than any other individual. As the complex pathophysiology of diverticulosis

sis better understood, more effective nutrition therapy interventions will follow.

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Mrs. K is a 68 YOWF who is 54 and weighs 170 lbs. She is a German widow

who lives by herself in central Michigan. She has raised four children; all are well and

live in other cities. Mrs. K has a FH of CHD on her fathers side of the family. Her

brother died of MI when was 72 and her father had two MIs before dying of a stroke at

the age of 70. Mrs. Ks mother died of intestinal cancer when she was 81.

Mrs. K does not smoke. She will drink a glass of wine occasionally. Other than a

cold each winter, Mrs. K has been relatively healthy. She did have pneumonia five years

ago and required hospitalization, but recovered quickly. She has been taking guanfacine

hydrochloride (Tenex) for five years. Mrs. K has been on a weight reduction diet in the

past but without much success.

Almost a year ago, Mrs. K was bothered with some abdominal discomfort,

particularly in the LLQ, where she had some colicky pains. The discomfort lasted for a

couple of days and passed. She noted an increased amount of flatus also. She did pay

attention to the problem since it passed. A few weeks later she experienced similar

discomfort in the LLQ again with increased flatus. That episode also passed after a

couple of days. Mrs. K continued to have these attacks on a more frequent basis. She

noted rather severe pain and flatus when she ate foods that normally gave her gas, live

navy beans and cabbage. As the attacks became more frequent and severe, Mrs. K was

also having problems with constipation. This was something that was not a problem

previously. She tried taking a laxative, Correctol (phenolphthalein), but ended up with

diarrhea and more cramps.

About a month ago, she had a very severe attack. Severe pain in the LLQ,

tenderness, a temperature of 100, and diarrhea continued for three days before Mrs. K

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decided to go to the doctor. He prescribed ampicillin (Ampicin) and scheduled her to

have a BE on an outpatient basis. The results indicated diverticulitis in the sigmoid and

descending colon. The physician continued Mrs. K on ampicillin for ten days and placed

her on a low fiber diet. He had her see the clinic dietitian before she went home and

asked her to come back and see him in two weeks. If she improved, he would change her

diet and discharge her.

Mrs. K followed her diet for a while, but when she felt better, she did not see any

reason to do so. She was supposed to take a stool volume expander daily and drink plenty

of fluids. She did not like the taste or consistency of the two different brands of stool

volume expanders she tried, so she did not take any. The fluids made her go to the

bathroom too much, so she did not do that either. Mrs. K continued to have pain in the

LLQ on occasion, but it would go away in a few days. She started to have increased

instance and severity of constipation followed by diarrhea. She did not associate that with

diverticulitis. She though it was something she at and did not pay it any attention.

Last week she had another severe attack with considerable pain and diarrhea.

During these attacks she does not eat much because of the discomfort. One evening, after

having suffered with the symptoms for two days, Mrs. K was looking at TV and feeling

much better. She was hungry from not eating but did not feel like fixing herself anything.

A commercial came on for popcorn and reminded her that she had some microwave

popcorn in the house. She prepared and ate the whole package. She awoke that night with

severe cramps, flatus, and felt very weak. The cramps got worse and diarrhea started.

When she went to the bathroom, she passed a lot of bright red blood. This frightened her

so much she called her physician. He had her go to the emergency room where, upon

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examination, she was found to be experiencing slight rectal bleeding. She was admitted

for observation and tests.

Mrs. Ks labs taken in the ER were as follows:

WBC 13 x 10/L Hgb 11g/dL Hct 35% Na 135mEq/L

K 3.5 mEq/L Cl 99 mEq/L BUN 12mg/dL Cr 0.9 mg/dL

All other labs were OK. The next morning Mrs. K felt worse. She was weaker and

had chills. Her T was 101. The doctor made her NPO and stared I.V. fluids and

antibiotics the previous night. A stool test was still positive for blood. After the diarrhea

stopped, a colonoscopy was done and severely inflamed diverticula were found in the

sigmoid and descending colon. The MD speculated that Mrs. K had been bleeding

slightly for some time because of erosion that was taking place in her sigmoid colon. He

suspected that the heavier bleeding was due to the breaking of a very small blood vessel.

His recommendation was removal of the sigmoid colon and a part of the descending

colon.

Mrs. K had a partial colectomy with a resulting colostomy. She survived the

surgery without incident and incident and post-op recovery went well.

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NCPAssessment

Domain 1-Food/Nutrition-Related History (FH)-

24-hour Recall

Breakfast:
2 slices buttered toast/jelly
cup hash brown
Scrapple
Coffee with 2 T cream and 2 tsp sugar

Lunch:
3 oz. pork roast
1 c boiled potatoes
c carrots
c sauerkraut
Coffee with 2 T cream and 2 tsp of sugar

Dinner:
2 slices buttered toast
1 c tapioca pudding
Coffee with 2 T cream and 2 tsp sugar

Anthropometric Measurements:
H: 5 4 or 1.62 m
W: 170 lbs. or 77.27 kg
BMI = 29.5 Overweight

Biochemical Data:

WBC 13 x 10/L Hgb 11g/dL Hct 35% Na 135mEq/L

K 3.5 mEq/L Cl 99 mEq/L BUN 12mg/dL Cr 0.9 mg/dL

Nutrition Focused Physical Findings (PD) - physical appearance, muscle and fat

wasting, swallowing function, appetite, and affect.

Client History:

Mrs. K has a FH of CHD on her fathers side of the family. Her brother died of MI when

was 72 and her father had two MIs before dying of a stroke at the age of 70. Mrs. Ks

mother died of intestinal cancer when she was 81. Mrs. K does not smoke. She will drink

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a glass of wine occasionally. Other than a cold each winter, Mrs. K has been relatively

healthy. She did have pneumonia five years ago and required hospitalization, but

recovered quickly. She has been taking guanfacine hydrochloride (Tenex) for five years.

Mrs. K has been on a weight reduction diet in the past but without much success.

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NCPDiagnosis

PES Statement #1:

Inadequate fiber intake related to lack on nutrition education as evidenced by unstable

diet.

PES Statement #2:

Altered GI function related to irregular bowels as evidenced by constant diarrhea.

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NCPIntervention

Im placing Mrs. K on a high-fiber diet. It is the recommendation for people with

diverticulosis. For the time being, I want Mrs. K to go to nutrition counseling due to her

lack of persistence on following her diets and prescriptions.

The National Digestive Diseases Information Clearinghouse guidelines state that eating

a high-fiber diet is the only requirement highly emphasized across the medical literature.8

The guidelines also note that no scientific data support this treatment; therefore,

eliminating specific foods is not necessary. In addition, the Academy's Nutrition Care

Manual states that it is generally accepted that high-fiber nutrition therapy is

recommended for diverticulosis, and although avoidance of nuts, seeds, and hulls has

been historically recommended, recent literature suggests that this is not necessary.

(National Digestive Diseases Information Clearinghouse)

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NCPMonitoring and Evaluating

I would like Mrs. K to come check in after one month of starting her new diet. I will then

check to see if she still has blood in her stool and if she experiences any pain. I will then

monitor her eating habits through a 24-hour recall as well as a food diary for the past few

weeks.

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References

Nahikian-Nelms, Marcia. Nutrition Therapy and Pathophysiology. Belmont, CA:

Wadsworth, Cengage Learning, 2011. 423-24. Print.

Frequently Asked Questions of the Academy's Knowledge Center. Peregrin, Tony. Journal
of the Academy of Nutrition and Dietetics, Volume 113, Issue 7, 891

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