DIVERTICULITIS: DEFINITION & DIET

NUTRIDIET BSN 401 STI GLOBAL CITY

Members: Jumarang, Kim Enrico M. Gabrillo, Fatima Jadraque, Jhusty Ryan Arnaldo, Margaux Vittoria Tebia, Dan Gavino, Mona Krizza Dequito, Reidzmir Shaun Gonzales, April Jane Villarta, Alex Tungol, Edward Joven

What is diverticulitis?
Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material. Pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to in the plural as diverticula. Diverticula can occur throughout the colon but are most common near the end of the left colon referred to as the sigmoid colon. The condition of having these diverticula in the colon is called diverticulosis. A person with diverticulosis may have few or no symptoms. When a diverticulum ruptures and infection sets in around the diverticulum, the condition is called diverticulitis. An individual suffering from diverticulitis may have abdominal pain, abdominal tenderness, and fever. When bleeding originates from a diverticulum, it is called diverticular bleeding. A person who suffers the consequences of diverticulosis in the colon is referred to as having diverticular disease.

Therefore, A person having diverticulosis (the condition), and perhaps diverticulitis (the inflammation) as well, is said to have diverticular disease.

Symptoms
Most people with diverticulitis have few or no symptoms. Twenty percent of those with diverticulitis will develop symptoms related to diverticulosis. The most common symptoms of diverticulitis include: diarrhea, constipation, and abdominal cramping. an abscess in the pelvis colon obstruction bleeding into the colon bacterial peritonitis in the abdominal cavity.

More serious complications include:

Pathophysiology
Diverticula are small mucosal herniations protruding through the intestinal layers and the smooth muscle along the natural openings created by the vasa recta or nutrient vessels in the wall of the colon. These herniations create small pouches lined solely by mucosa. Diverticula can occur anywhere in the gastrointestinal tract but are usually observed in the colon. The sigmoid colon has the highest intraluminal pressures and is most commonly affected. Diverticulosis is defined as the condition of having uninflamed diverticula. The cause of diverticulosis is not yet conclusive, but it appears to be associated with a low-fiber diet, constipation, and obesity. Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear. Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This obstruction may result in distension of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then ensue. Alternatively, some believe that increased intraluminal pressure or inspissated food particles cause erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation. The disease is frequently mild when pericolic fat and mesentery wall off a small perforation. However, larger perforations and more extensive disease lead to abscess formation and, rarely, intestinal rupture or peritonitis. Fistula formation is a complication of diverticulitis. Fistulas to adjacent organs and the skin may develop, especially in the presence of an abscess. In men, colovesicular fistulas are the most common. In women, the uterus is interposed between the colon and the bladder, and this complication is only seen following a hysterectomy. The uterus precludes fistula formation from the sigmoid colon to the urinary bladder. However, colovaginal and colocutaneous fistulas can form but are uncommon. Recurrent attacks of diverticulitis can result in the formation of scar tissue, leading to narrowing and obstruction of the colonic lumen.

Possible Cause
Although not proven, the dominant theory is that a low-fiber diet causes diverticular disease. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber, called soluble fiber, dissolves easily in water. It takes on a soft, jelly-like

texture in the intestines. Insoluble fiber passes almost unchanged through the intestines. Both kinds of fiber help prevent constipation by making stools soft and easy to pass. Constipationor hard stoolmay cause people to strain when passing stool during a bowel movement. Straining may cause increased pressure in the colon, which may cause the colon lining to bulge out through weak spots in the colon wall. These bulges are diverticula. Lack of exercise also may be associated with a greater risk of forming diverticula, although the reasons for this are not well understood.

Treatment
Treatment for diverticulitis focuses on clearing up the inflammation and infection, resting the colon, and preventing or minimizing complications. Depending on the severity of symptoms, the doctor may recommend bed rest, oral antibiotics, a pain reliever, and a liquid diet. If symptoms ease after a few days, the doctor will recommend gradually increasing the amount of high-fiber foods in the diet. Severe cases of diverticulitis with acute pain and complications will likely require a hospital stay. Most cases of severe diverticulitis are treated with IV antibiotics and a few days without food or drink to help the colon rest. In some cases, surgery may be necessary.

Diet
A low-residue diet, aka low-fiber diet, is usually recommended during the flare-up periods of diverticulitis to decrease bowel volume so that the infection can heal. An intake of less than 10 grams of fiber per day is generally considered a low residue diverticulitis diet. If you have been on a low-residue diet for an extended period of time, your doctor may recommend a daily multivitamin supplement. When symptoms of diverticulitis improve, you may ease off of the low-residue diet and gradually add more fiber back into your diet. A high-fiber diet is very important in preventing future diverticulitis attacks. As you increase your fiber intake, don't forget to increase your fluid intake as well. The increased fiber in this diverticulitis diet plan produces more bulk in the stool, reducing pressure in the colon and assisting the more regular and complete elimination of waste, thereby preventing the formation of further diverticula.

Foods to Eat
Breads and grains (6-11 servings daily) Bread, pastas, pizzas, pancakes, muffins, bagels, pita bread (use whole-grain, whole-wheat flours, and add 2-3 tsp of unprocessed wheat bran to, or substitute oat bran for one third of allpurpose flour in homemade breads, muffins and other baked goods) Whole-wheat, whole-grain and bran cereal products Buckwheat and stone-ground cornmeal Rye bread Whole wheat crackers or crisp breads Oatmeal, oat bran, or grits Barley, dry Wheat germ Whole wheat pasta Brown rice

Eat raw or dried fruits and raw vegetables if possible chopping, peeling, cooking, pureeing, juicing, and processing fruit and vegetables may reduce fiber content. Vegetables (3-5 servings daily) Fruit (2-4 servings daily) Milk/dairy (2-3 servings daily) Increase fiber in yogurt or cottage cheese by adding fresh fruit, whole grain or bran cereals. Meat/meat substitutes (2-3 servings or total of about 180 gm or 6 oz daily)

Foods to Avoid
Any hard or difficult-to-digest foods, such as nuts, corn, popcorn hulls, and sunflower, pumpkin, caraway, and sesame seeds.