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Diverticular Disease/Diverticulitis - Coggle Diagram
Diverticular Disease/Diverticulitis
Diverticular Disease vs Diverticulitis
Diverticular Disease
: occurs when small pouches develop in the lining of the large bowel
Diverticulitis
: if these pockets become inflamed
or infected, this is known as diverticulitis.
Symptoms
Abdominal pain and bloating
Altered bowel habits - diarrhoea and/or constipation
Usually no symptoms unless infection/inflammation occurs
Bleeding
Distension
Frequent motions/urgency
Nausea/vomiting
Left lower quadrant pain (70% of patients)
Pathogenesis
No clear cause known
Being physically active, maintaining a healthy weight and limiting your consumption of red meat (less than 455g cooked red meat per week) is recommended
Healthy diet with adequate fibre thought to reduce risk of flare ups
Fibre
Foods high in fibre
Nuts and seeds
Wholegrain, brown breads, cereals, rice, pasta
Legumes e.g. baked beans, lentils, kidney beans, soy beans
raw vegetables, fruits with skin, pips or fibrous texture - apples, pears, oranges, pineapple, dried fruits
popcorn, coconut, chocolate with nuts and fruit
Role of Fibre
: to promote healthy bowel function. Adds bulk to the stool and absorbs water to keep it soft, and easy to pass
Foods low in fibre
white bread, muffins, scones, rice, pasta
well cooked, peeled vege - potato, sweet potato, pumpkin, carrot, zucchini, broccoli, asparagus tips, mushrooms
melons, cherries, seedless grapes, pealed peaches & nectarines, banana, well cooked with no skin/pips, canned fruit
all milk, yoghurt, cheese
all meat, chicken, eggs, tofu
Stages of Diverticular Disease
Stage II
: pelvic abscess
Stage III
: perforated diverticulitis causing generalised purulent peritonitis (inflammation of the peritoneum)
Stage IV
: rupture of diverticula into the peritoneal cavity with faecal contamination causing generalised faecal peritonitis
Stage I
: phlegmon (inflammation of soft tissue) or localised pericolic (situated at the side of the large bowel) or mesenteric (occurring within the mesenteric organ) abscess
Possible P
Excessive fibre intake
Altered GI function
Inadequate fibre intake
Diet Interventions
Mild Diverticulitis
3) Increase in fluid consumption - 35-45mL/kg/d
2) ONS may be indicated during acute phase
4) Progression to low fibre diet (<10g/d)
5) Progression to normal diet with fibre meeting national guidelines as tolerated
1) Bowel rest - NBM or clear fluids may be indicated
Diverticular Disease
Fluid - 30-35mL/kg/d
Avoid alcohol and caffeine
Fibre - gradual increase to high fibre diet. F=25g/d & M=30g/d
Overweight/obese patients wt loss reccomended
Balanced diet
Severe Diverticulitis
4) Progression from clear fluids with ONS as required/tolerated
5) Progression to low-fibre diet (<10g/d)
3) TPN may be indicated
6) Progression to normal diet with fibre meeting national guidelines as tolerated
2) IV fluids
1) NBM
INTERVENTIONS
HIGH FIBRE
Most vegetables and where possible eat the skin when
having vegetables
All fresh fruit, dried fruit and where possible eat the skin when
having fruit
Wholemeal/ wholegrain bread, cereals, pasta, brown rice, quinoa, chia seeds, psyllium husks, dried fruit, nuts and seeds
Flavoured milk with added fibre
(e.g. Up&Go)
Legumes e.g. baked beans,
lentils, soy beans, kidney beans
Popcorn, coconut & chocolate with dried fruit and nuts
LOW FIBRE
White bread, crumpets, refined cereals (rice bubbles), white rice, and white pasta
Pawpaw and melon (no seeds), cherries, seedless grapes, peeled nectarines & peaches, well cooked fruit, canned fruit except pineapple
All milk, Plain yoghurt, custard, Fruche, plain cheese, plain or flavoured icecream
All meat, chicken, fish, tofu and eggs
Pg. 206 in handbook