Assessment

HISTORY. Patients with diverticulosis are generally asymptomatic but may report cramping abdominal pain in the left lower quadrant of the abdomen that is relieved with episodes of flatulence and a bowel movement. Occasional rectal bleeding may also be noted. Patients with diver-ticulitis usually report cramping in the left lower quadrant with abdominal pain that radiates to the back. Other complaints frequently reported are episodes of constipation and diarrhea, low-grade fever, chills, weakness, fatigue, abdominal distension, flatulence, and anorexia. Patients may report that symptoms often follow and are accentuated by the ingestion of foods such as popcorn, celery, fresh vegetables, whole grains, and nuts. Symptoms are also aggravated during stressful times.

PHYSICAL EXAMINATION. Because diverticular disease is a chronic disorder that generally alters a patient's nutritional intake, inspect for malnutrition symptoms such as weight loss, lethargy, brittle nails, and hair loss. Assess vital signs since temperature and pulse elevations are common. Palpate the patient's abdominal area for pain or tenderness over the left lower quadrant. Palpate for a mass in this area, which may indicate diverticular inflammation.

PSYCHOSOCIAL. Because emotional tension and stress commonly precipitate episodes of diverticulitis, determine the patient's current stressors and his or her coping mechanisms and what type of support system is available.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Computed tomography

No abnormalities

Diverticula, localized colonic wall thickening (>5 mm)

Abnormalities can be located, such as diverticula, abscesses, fistulas, and pericolic fat inflammation; excludes other pathologies

Technetium 99 m sodium pertechnetate (gastric or Meckel's) scan

Normal gastric mucosa

May demonstrate diverticula

Highlights the presence of mucosal abnormalities

Abdominal x-rays: acute abdominal series, with flat and upright abdominal imaging

Normal abdomen

Identifies perforation lower quadrant mass

May show signs of free air if the GI tract has perforated; identifies signs of intestinal irritation (ileus), volvulus, bowel obstruction

Other Tests: Stool specimen, angiography if bleeding is occurring, and complete blood count. Barium enema usually fails to identify diverticulum. Lipase/amylase and liver function tests, ultrasound, sigmoidoscopy.

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