 Welcome to Nursing School Explained in this video on diverticulosis and diverticulitis. First of all, let's look at the pathophysiology and see how those diverticular form. So risk factor for developing either one of those two is a low-fiber diet, which then, when there's less bulk in the stool, the transit time takes longer, so the transit time is decreased for the food to be processed. The longer the stool sits in the colon, the more water gets absorbed from it, and the more water gets absorbed, the more harder and smaller the stool is that actually finally gets eliminated. Now with the decreased stool size, it increases the pressure in the lumen of the colon, and that's presses that puts stress on the wall of the colon, and then because of that stress, the wall gets weakened in this diverticular form. Now besides low-fiber diet, other risk factors also include obesity, inactivity, smoking, alcohol intake, as well as immunosuppression. So you can see a lot of this diverticulosis or the development of diverticular is related to just overall poor lifestyle choices such as inactivity, obesity, poor diet, and all those consequences. If we look at this drawing here, here we have the ascending, transverse, and descending colon, and then here we have these out-pouchings, which are these diverticula, which are these weaknesses in the colon wall, and then these pouches form, and when the pouches are here in green, that would just be called diverticulosis, that's the presence of diverticula. But they can get, food can get stuck in there, and then they become very inflamed, and as you know, the medical abbreviation for inflammation is idus, so then when the diverticula become inflamed, it leads to diverticulitis. Over here for diverticulosis, signs and symptoms, many times the patient does not have any, and then it's just discovered on a routine colonoscopy where through visualization the provider is able to see these out-pouchings, this diverticula, that are in the person's colon. Treatment for diverticulosis, because it's a consequence of low diet, poor diet with low fiber intake, we want to increase the fiber, the diet, we want to increase activity, we want to make sure the patient, if there are no contraindications, drinks at least 2 liters of water per day, and decreases abdominal pressure, so that would be anything, maybe tight fitting clothing, or lots of bending, lifting, straining, can cause pressure on the abdomen, which can cause diverticulosis. So diverticulosis in general is just very, very mild and can usually be managed with just diet and activities or lifestyle changes. However, when the diverticula become inflamed and diverticulitis occurs, the patient many times presents with acute left lower quadrant pain. And the reason is that the most of the diverticula usually occur in that descending colon, hence we have that left lower quadrant abdominal pain. There might be a pop of a mass, because the diverticula can get quite large and then the inflammation that occurs, so we can palpate that. Many times, as with anything that causes abdominal pain, the patient will have nausea and vomiting. And they also might have signs and symptoms of infection, because we're dealing with this inflamed diverticula here. So this might be fever, chills, as well as objective findings, such as in lab results, increased white count, increased neutrophil count. Diagnostic tests to see the state of the inside of the colon would be a CT scan of the abdomen with oral contrast. And so the patient will swallow this contrast as it passes through the colon. The scan was performed and it lights up the colon and then it will also light up the diverticula or these outpouchings. Certainly want to look at the CBC to determine the white count and their CRP inflammation markers is probably going to be increased. Treatment for diverticulitis, if there are mild symptoms, the patient might be able to tolerate PO antibiotics. But it is usually recommended to stay on a clear liquid diet to let that colon and that inflammation rest. Because at least the last thing that we want is to send lots of bulk forming agents through here. So this colon is inflamed that could certainly cause more inflammation and certainly more pain for the patient. If the symptoms are moderate to severe, the patient will require admission and IV antibiotics, as well as to be in PO to let the colon completely rest and recover from this inflammation. And then certainly they'll need IV fluids to handle their fluid needs if they can't take anything by mouth. If there were recurring episodes of this diverticulitis, where now there might be some scarring or some abscess formation, then maybe a partial colactomy will be recommended. But that all depends on how severe the symptoms are and how many episodes the patient has already had. Now complications from this, abscesses can form. So now if this diverticulitis here builds and builds and builds, it can build this abscess, which can certainly be very painful, but it can also burst. And then we have this inflammation that now extends from the colon into the peritoneum causing peritonitis. And certainly patients with abscess formation and peritonitis can be very ill and become septic. Because now we have all the contents of the colon that have now spilled into the abdominal cavity and everything is inflamed. As for nursing care, when we have mild symptoms or the patient just has diverticulosis, we need to educate them about these lifestyle changes. But in the acute phase, if they get admitted for diverticulitis, certainly we need to monitor the vital signs and also train their labs, specifically their white count and their CRP. And we need to do focus abdominal assessments to make sure that if this complication of abscess or peritonitis occurs, then we are able to detect this early, maybe when the abscess occurs before it can burst and develop into peritonitis. One other caveat that used to be a trait of thought that an intake of nuts and seeds, as well as strawberries that have that tiny little, these tiny little black dots on them, could be the cause for diverticulitis, where the thought was that they get stuck in these out pouches causing the inflammation. That sort of thought has now been kind of put aside and it is now no longer recommended to hold off on eating any nuts and seeds with inpatients who have diverticulosis. Thank you for watching this video. Please also watch the video on peritonitis so that you can become more familiar what happens with this complication. Thanks for watching Nursing School Explains to you soon.