Diverticulitis is a common gastrointestinal condition that affects millions worldwide, particularly in adults over 40. It begins with diverticulosis—the formation of small pouches (diverticula) in the colon wall—and can progress to diverticulitis when these pouches become inflamed or infected.
Understanding the Pathophysiology
Diverticulosis
- Small pouches (diverticula) develop in the colon wall, often due to increased intraluminal pressure from chronic constipation.
- Frequently asymptomatic.
- Commonly linked to low-fiber diets.
Diverticulitis
- Occurs when diverticula become inflamed or infected.
- Can lead to swelling, perforation, and abscess formation.
- Inflammation may result from trapped fecal matter or bacteria in the diverticula.
Causes and Risk Factors
Primary Causes
- Low-fiber diet → constipation → increased bowel pressure
- Consumption of popcorn, seeds, nuts (may lodge in pouches, though evidence is debated)
Additional Risk Factors
- Aging (weaker bowel walls)
- Obesity
- Sedentary lifestyle
- Smoking
- Use of NSAIDs or steroids
Signs and Symptoms
Classic Presentation
- Pain in the Left Lower Quadrant (LLQ) – commonly in descending or sigmoid colon
- Fever and chills
- Changes in bowel habits (constipation or diarrhea)
Laboratory Findings
| Lab | Expected Change |
|---|---|
| WBC | Elevated (infection) |
| Hemoglobin/Hematocrit | Decreased (possible bleeding) |
Complications of Diverticulitis
The most dangerous complication is peritonitis, a life-threatening infection of the abdominal cavity.
Signs of Peritonitis (NCLEX Tip):
- LUQ abdominal pain
- Rigid, board-like abdomen
- Fever, tachycardia
- Severe tenderness and rebound tenderness
Never perform a barium enema or colonoscopy during acute diverticulitis—these increase the risk of perforation.
Nursing Care Priorities
Highly Tested NCLEX Nursing Interventions
1. Avoid constipation and straining
- Prevents worsening of diverticular inflammation.
2. NPO (Nothing by Mouth) during acute phase
- Allows bowel rest.
3. Pain management
- IV opioids like morphine or hydromorphone.
- Maintain hydration when oral intake is restricted.
Dietary Guidelines
During Acute Flare-Up (Diverticulitis)
- NPO initially → clear liquid diet (jello, broth, juices)
- Low-fiber diet until inflammation resolves
For Prevention (Diverticulosis)
- High-fiber diet to keep bowels clean and prevent constipation
- Adequate hydration
- Avoid foods that may irritate diverticula (popcorn, seeds, nuts)
Dietary Transition Table:
| Stage | Diet Focus | Examples |
|---|---|---|
| Acute Flare | NPO → clear liquids → low fiber | Broth, gelatin, white bread |
| Recovery | Gradual fiber increase | Cooked vegetables, oatmeal |
| Prevention | High fiber, high fluid | Beans, whole grains, fresh fruits |
NCLEX Practice Question Example
Question:
A patient with acute diverticulitis presents with severe LLQ pain, fever, and elevated WBC. Which order should the nurse question?
- NPO status
- IV normal saline
- Pain medication
- Colonoscopy
Correct Answer: 4. Colonoscopy – contraindicated during acute inflammation due to risk of perforation.
Long-Term Management & Patient Education
Prevention Tips
- Maintain a high-fiber diet (once recovered)
- Exercise regularly
- Avoid straining during bowel movements
- Stay hydrated
- Monitor for recurrent symptoms
Patient Teaching Points
- Recognize early signs of recurrence
- Avoid NSAID overuse (linked to GI bleeding)
- Follow-up colonoscopy only when inflammation is resolved
Quick Comparison: Diverticulosis vs. Diverticulitis
| Feature | Diverticulosis | Diverticulitis |
|---|---|---|
| Pathology | Pouches (diverticula) in colon wall | Inflamed/infected pouches |
| Symptoms | Often none | LLQ pain, fever, chills |
| Diet | High fiber | Low fiber during acute flare |
| Risk | Progression to diverticulitis | Complications like peritonitis |
Frequently Asked Questions (FAQ)
1. Can diverticulitis heal without surgery?
Yes, many cases respond to rest, antibiotics, and diet changes. Surgery is reserved for recurrent or complicated cases.
2. Why avoid colonoscopy during flare-up?
Because inflammation increases perforation risk—colonoscopy is safe only after recovery.
3. Is popcorn always bad for diverticulosis?
Historically, popcorn, nuts, and seeds were avoided, but recent studies suggest they may not always cause flare-ups—still, some patients are sensitive.
4. How much fiber is recommended for prevention?
Typically 25–35 grams/day from fruits, vegetables, beans, and whole grains.
