Diverticulitis

The patient with symptoms of diverticulosis may progress into acute diverticulitis. He or she may have experienced several episodes of diverticulosis before this change or, equally, this may be the first episode. This disease is an acute inflammation and infection of the diverticulum, giving rise to symptoms of acute pain, fever and nausea, and necessitates hospital admission. Diverticulitis can also mean perforation, fistula or abscess. Careful assessment of the patient is essential at this...

The Popular Sector

This is the area of the layperson who is not a specialist or professional, and it is often in this area that ill-health is first recognized. This sector includes all the therapeutic options available to the public that do not require payment or consultation with medical practitioners or folk healers. This area mainly includes self-medication, and a study by Dunnell and Cartwright in 1972 found that the use of self-prescribed medication was twice as common as the use of prescribed drugs....

Morbidity and Mortality

The surgical management of left-sided colon emergencies such as diverticular disease and colorectal cancer is moving towards a single surgical procedure but patient selection for a single or staged procedure appears to remain controversial. The choice of operative procedure depends on the patient's health and a single-stage operation is preferable and often achievable even in elderly people with peritonitis, as a result of the advances in intensive care medicine and the management of peritoneal...

Diverticular disease in Africa

It is often postulated that diverticular disease is virtually unknown in black Africans who live south of the Sahara in rural environments and who have not changed their traditional high-residue diet (Segal et al., 1977). As many black South Africans began to move from the rural areas to urban industrialized areas around Johannesburg, their social and educational development became more sophisticated than their rural counterparts. When comparing the dietary intake of the two groups of black...

Current Thinking

As has been seen, diverticular disease is common in the western world and can carry a significant morbidity. Although diverticular disease is common, it is still poorly understood and recent advances in the field continue to focus on the technological side (Cima and Young-Fadok, 2001). Improved computed tomography (CT) allows diagnosis and assessment to be made of severe acute diverticular disease and specialized teams using advanced endoscopic techniques are able to control diverticular...

Colonoscopy Figure

A patient who has known diverticular disease may present a problem for the inexperienced endoscopist. The diverticula look like the bowel lumen but in fact are blind ends it takes a skilled endoscopist to negotiate the diverticular bowel. The examination is usually one where diverticular disease is an incidental finding. The investigation is not one of choice in the acute stage because of the risk of the perforation with the endoscope. Figure 3.3 Colonoscopy showing a diverticulum. Figure 3.3...

Plain abdominal radiograph and barium enema

Pancreatic Cancer Barium Enema

A barium enema (Figures 3.1 and 3.2) is the gold standard for demonstrating the severity of colonic diverticular disease (Halligan and Saunders, 2002). The radiograph involves the radio-opaque substance barium being inserted into the colon as an enema. There are two different barium enemas a single contrast where barium alone is used and barium and air as a double-contrast barium enema. The patient has to have his or her bowel cleansed and all radiology departments have their own method of...

Cultural Attitudes

Black (2000) describes explanatory models and semantic networks used by patients and healthcare workers who may have preconceived ideas about patterns of illness and how that illness should be interpreted and treated. Kleinman (1980) describes five core points used to distinguish notions about episodes of sickness and treatment. He describes these as core clinical functions of how systems of medical knowledge and practice enable people culturally to construct illness as a psychosocial...

Diverticular disease in Greece

An epidemiological study looking at biosocial factors and diet in Athens was undertaken by Manousos et al. (1985) using the dietary availability that is known in Greece, which enables an epidemiological study to be satisfactorily undertaken. A hundred cases of diverticulosis confirmed by barium enema radiological studies were hospitalized in Athens. These were consecutive cases who had been diagnosed for the first time with diverticulosis. Dietary histories were obtained and also socioeconomic...

Aromatherapy

Aromatherapy is massage using aromatic plant extracts and essential oils and has become increasingly popular in the western world. As with herbalism, it is believed that plants have healing properties and their scent can affect mood and stress levels. Aromatherapy massage brings together two areas, the scent of the plants being used in massage oil and the touch of the masseuse. Although the true termination of therapeutic touch is in the realm of healing, where the healer holds his or her hands...

The Surgery Figures 71 and

The laparotomy enables the surgeon to view the abdominal cavity in order to see where the perforation has occurred in the bowel. The CT should indicate the site of the perforation and the site for resection. The presence of faecal contamination can preclude anastomosis of the bowel and surgery can be a Hartmann's operation that includes an end-stoma in the form of a colostomy. This type of surgery is intended to be a two-stage procedure, because the colostomy, at a future date, will need to be...

Case

Jane was admitted 3 months after her emergency surgery for reversal of the Hartmann's operation. Jane had spent the previous 3 months at home trying to adjust to life with a colostomy. She had managed to some extent but had not ventured out of her house very often. Jane had put her life on hold, waiting for a date for her reversal operation. During Jane's last outpatient appointment the colorectal surgeon examined the wound, which had taken a further 4 weeks to heal, after Jane's discharge from...

Sage

The types of complementary or alternative therapies that may specifically help in diverticular disease are Even though these therapies may offer the patient help or relief from symptoms, they do not replace western orthodox medicine when there are associated complications in diverticular disease, such as haemorrhage, fistula, obstruction and abscess. Often daily ingestion of 'live bacteria' in the form of Acidophilus, Bifidus and Lactobacillus, in yoghurt, yoghurt drinks (Actimel, etc.) or...

Uncomplicated Diverticular Disease

Uncomplicated diverticular disease or diverticulosis is a disease of the twentieth century that is thought to be associated with diet. Throughout the century, a fundamental dietary and eating pattern change also took place. Food is no longer a home-cooked meal made from fresh ingredients, such as meat and two vegetables, but something that has been processed and precooked with the addition of preservatives, taste enhancers and various other additives. There is a movement away from the tradition...

References

Boston John Wright. Aldoori W, Ryan-Harsham M (2002) Preventing diverticular disease. Review of recent evidence on high fibre diets. Canadian Family Physician 48 1632-7. Aldoori WH, Giovanucci EL, Rimm ER et al. (1995) Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut 36 276-82. Aldoori WH, Giovaucci EL, Rockett HR, Sampson L, Rimm EB, Willett WC (1998) A prospective study of dietary fibre types and symptomatic...

Diverticular disease in Scandinavia

In radiological contrasts undertaken by Kohler (1963) on a Finnish and southern Swedish population, he found that the contrast enema rarely showed diverticular disease in the Finnish population, yet using the same radiological medium diverticular disease appears to be more common among the southern Swedish population. Although diverticular disease can be demonstrated by radiological studies with barium enemas and by double contrast, much of the statistical evidence is dominated by the UK and...

Hidden Problems in Stoma Care

As the proportion of people aged over 65 continues to grow, the proportion of elderly patients with stomas continues to grow (Ebersole and Hess, 1998). Currently, in the UK the average life expectancy is 83 years for men and 87 years for women. Certain areas of the UK, especially on the south coast of England, have high populations of people over the age of 70 years - as high as 27.9 . In 2000, 10.6 of the population was over the age of 80 (Black, 2000). For many of these patients, there are...

Cultural Issues

Diverticular disease of the large bowel in western societies is common and it appears that the prevalence of this disease increases with age (Horner, 1958 Hughes, 1969 Parks, 1968 Sim and Scobie, 1982 Thompson et al., 1982). Much of the population in Europe, North America and Australia may develop the disease and it is often quoted by healthcare professionals that diverticular disease is rare among African peoples yet Africans adopting a western lifestyle become susceptible to the disease...

The Folk Sector

The folk sector is an ill-defined area with its 'practitioners' aiming at holistic treatment of their patient. Such 'practitioners are faith healers, herbalists, clairvoyants, and the forms of diagnosis and healing are to be found in complementary and alternative medicine, with as many as 13 of the population seeking help from a complementary or alternative therapist every year' (Fulder, 1988). The herbal practitioner believes that disease is an imbalance of the physiological mental emotional...

The History of Diverticular Disease

The written history of bowel-associated problems can be traced as far back as the Book of Judges in the Bible showing that the pre-Christian Israelites were well aware of abdominal injuries and problems (Black, 2000). But, even before the Bible recordings, the Egyptians in 2000 bc recognized disorders of the bowel, although writings often recorded on papyrus were not specific as to what these may have been. The Greeks and Romans were not to be left out in their writings on bowel problems...

Diverticular disease in the Japanese in Hawaii

The Japanese are the second most numerous population to reside in Hawaii and offer the researcher a wider population of sex, age and long-term residence. The class level of the Japanese in Hawaiian society is that of a middle-class society. Diverticulitis in Hawaiian Japanese differs from that found in other races in Hawaii and occurs most often on the right side in the ascending colon (Stemmermann, 1970). This correlates with the incidence of right-sided diverticulitis previously discussed,...

Teaching the Adult Stoma Patient

Teaching stoma care to the new patient entails an assessment of the patient's readiness to learn and his or her cognitive and psychomotor abilities to understand strategies for appliance changing. The life-changing effect of stoma formation, whether the stoma is to be temporary or permanent, leaves the patient facing an altered body image and self-concept. The patient must learn new ways of caring for him- or herself that are different from the expected 'norm'. Good basic teaching principles...

Colostomy

A colostomy may be formed in the sigmoid colon, descending colon, transverse colon or ascending colon, and the type of output will depend on the location of the colostomy. When a colostomy is situated in the ascending colon or the transverse colon, the faecal output may vary from a fluid output to a semi-formed stool. For these stomas the optimal appliance to use is a drainable appliance such as would be used if the stoma were an ileostomy. Transverse loop colostomies are often positioned in...

Gender and Age in Diverticular Disease

Although literature subscribes to the view that Littre, in 1732, was the first to mention diverticular disease, his description of 'diverticular hernia' was not explained. The first description is attributed to Sommering in his translation into German of Baillie's Morbid Anatomy in 1794 (Oschner and Bargen, 1935). In 1968, Parks reported on the natural history of diverticular disease and found that women were more likely than men to be affected with up to 60 of patients being women. Since 1968,...

Body Image

The social taboos that surround body matter elimination are legion, so that, when a stoma is raised as a surgical procedure, as either an elective procedure or an emergency one, the individual's body image changes for ever. Stoma is derived from classical Greek meaning 'mouth' and is used as a medical term meaning 'artificial opening' Black, 2000 . Body image, the mental picture of physical being that individuals retain, develops from birth onwards and continues throughout life it is related to...

Aetiology

The historical perspective on the aetiology of diverticular disease can be recognized as far back as 1853 when Virchow Rankin and Brown, 1930 described inflammatory areas, particularly in the sigmoid colon flexures, as 'isolated circumscribed adhesive peritonitis' and in 1869 when Klebs investigated the relationship of diverticula and their associated blood vessels in the intestinal wall. In 1930, Rankin and Brown were describing diverticula and their aetiology as a controversial subject,...

Computed tomography

In the acute phase of diverticulitis it is important to have an accurate diagnosis. A straight abdominal radiograph is regularly the first to be ordered. This is followed by computed tomography CT if the results from the straight abdominal radiograph show that this is necessary. A variety of other abdominal radiological investigations is also available. The gastrogaffin swallow and follow-through or gastrogaffin enema is regularly used in patients who are thought to have an obstruction. This...

Stoma Siting

The careful siting of a stoma, whether temporary or permanent, plays an essential role in the rehabilitation of the patient. In elective cases, whatever the reason for a stoma, it is usual for the stoma care nurse to site the stoma preoperatively and to counsel the patient about the possible outcomes. All this takes place in a far more relaxed atmosphere where the patient can ask coherent questions about what is going to happen to him- or herself. Often, in the case of diverticulitis where...

Reversal of Hartmanns procedure Figure

The reversal of the Hartmann's procedure is the second stage of the operation. To most patients this is the most important part of the whole process. The operation does carry risks and is not as easy and straightforward as reversal of a loop colostomy. Hartmann's procedure involves Figure 7.3 Reversal of Hartmann's procedure. Courtesy of Dansac Ltd. Figure 7.3 Reversal of Hartmann's procedure. Courtesy of Dansac Ltd. another laparotomy and all the inherent risk associated with major bowel...

Anatomy and physiology of diverticular disease

Diverticular disease is a twentieth century disease that results in part from changes in diet, age and lifestyle although there is little research to support this Bassotti et al., 2003 . It is one of the most frequent diseases seen in gastroenterology departments. Diverticula are small herniations in the bowel wall they can occur anywhere in the bowel. The diverticular pouches usually appear in the descending and sigmoid colon Stollman and Rashkin, 1999 , frequently manifesting at the weakest...

The vagus nerve

The vagus nerve is the tenth cranial nerve and the longest of the cranial nerves its Latin meaning is 'wandering'. The nerve leaves the brain through the neck, into the thorax and abdomen. It supplies most of the muscles of the pharynx and soft palate. The vagus nerve enters the thorax and branches go to the lungs for bronchodilatation, to the oesophagus for peristalsis and to the heart to slow down the heart rate. In the abdomen, branches enter the stomach, pancreas, small intestines, large...

Anatomy and Physiology

The digestive system starts with the mouth and ends at the anus. The tract would measure approximately 10 metres if it were laid out in a straight line. The purpose of the digestive system Figure 2.1 is to produce a chemical and mechanical breakdown of food Ingestion the act of eating Digestion mechanical and chemical Figure 2.1 The digestive system. Courtesy of Dansac Ltd. Figure 2.1 The digestive system. Courtesy of Dansac Ltd. The digestive tract or alimentary canal is an epithelial lined...