Question The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources and professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. Case Study - Diverticulosis and Diverticulitis Case Study – Diverticulosis and Diverticulitis Activity Learning Outcomes Through this discussion, the student will demonstrate the ability to: Compare and contrast the pathophysiology of diverticular disease (diverticulosis) and acute diverticulitis. (CO1) Identif

Case Study – Diverticulosis and Diverticulitis

Diverticulosis and diverticulitis are infections of the gastrointestinal tract and affect the colon. However, diverticulosis causes budging in the colon due to pressure build-up, while diverticulitis causes intestinal obstruction. Diverticulitis occurs when the fecalith obstructs the diverticulum sac, which causes minimal inflammation and mucosal irritation. It also causes congestion, and as it progresses, it causes further blockage. Diverticulitis occurs in 10% to 25% of patients and is a diverticular disease complication. It can be classified as acute or chronic, depending on the presentation. In chronic diverticulitis, the patient presents with bowel perforations, fistulas, abscesses, and intestinal obstruction. Diverticulosis, on the other hand, appears in the walls of the large intestine as small pouches (Barbaro et al., 2022). The small pockets penetrate through the weak layers of the intestinal muscle, causing increased pressure in the colon, leading to a bulge, the point of weakness. Budging mainly occurs in the sigmoid and descending colon.

The patient complains of nausea and vomiting, which could result from an obstruction in the bowel, constipation, fever, and pain in the left lower quadrant which could be in episodes of ongoing or dull aches. In the clinical findings, stool for occult blood is positive, and hypotension suggests diverticulitis. Imaging results in the X-ray show a pattern resembling bowel -gas and is consistent in the ileus. No masses or abscesses were seen on the CT scan.

Risk factors that are associated with acute diverticulitis include old age. The risk of getting acute diverticulitis increases with age and peaks from the age of 60 years. Taking a diet with low fibre and high animal fats also increases the incidence of getting this disease because the low fibre in the diet causes an increase in colon pressure causing bulging in the weak areas of the intestines. Several medications, such as Nonsteroidal anti-inflammatory drugs like Ibuprofen, steroids, and opioids, are other risk factors for acquiring acute diverticulitis (Ma et al., 2022). These drugs cause injury directly to the mucosa and interfere with the synthesis of prostaglandins, causing weakness in the intestinal wall and increasing permeability to bacteria and toxins. Other risk factors include smoking, lack of exercise, and obesity.

Gastrointestinal diseases like acute diverticulitis can be treated with antibiotics such as rifaximin and metronidazole. Metronidazole works by diffusing into the organism, thus inhibiting protein synthesis of the causative agent through interaction with the organism’s DNA; it breaks the structure of the DNA and breaking of the strands hence the organism’s death. Side effects of this drug include dry mouth, an unpleasant metallic taste, abdominal pains, loss of appetite, and dizziness. It is contradicted by the use of alcohol, liver disease, pregnant or breastfeeding mothers, and patients who have an allergic reaction to it. Interaction between metronidazole and alcohol causes disulfiram effects, and the patients are advised to avoid alcohol when taking them (Piccioni et al., 2021) Rifaximin is a broad-spectrum antibiotic with an anti-inflammatory effect. It prevents protein synthesis by binding to the beta subunit of bacterial DNA-dependent RNA polymerase (RpoB). It causes side effects such as muscle stiffness, abdominal pain and bloating, dizziness, excess fatigue, and melena stool. Intravenous fluid administration is essential to avoid dehydration because many fluids are lost during diarrhea and vomiting. Later other clear fluids are also administered to see if the patient can tolerate them. However, once the patient presents with the above symptoms that suggest acute diverticulitis, fasting is advisable to allow the physicians to carry on with investigations and for the bowels to rest.

References

Barbaro, M. R., Cremon, C., Fuschi, D., Marasco, G., Palombo, M., Stanghellini, V., & Barbara, G. (2022). Pathophysiology of diverticular disease: from diverticula formation to symptom generation. International Journal of Molecular Sciences, 23(12), 6698.