Question

Topic: Altered Elimination, Pathophysiology.

Nutrition and elimination are closely linked. The purpose of this assignment is to demonstrate understanding of the pathophysiology of these conditions and the treatment of these conditions. Instructions For this essay you will focus on diverticulosis, a commonly encountered disease of altered bowel elimination. Compose a short (1 – 3 pages) essay explaining the risk factors, basic pathophysiology, and treatment of this common condition. You should include as part of your discussion an explanation of how the treatment modalities help to restore normal physiologic function.

Answer 1

Diverticulum is the outpouching of intestinal mucosa through the muscular wall of the intestine.Diverticulosis is multiple diverticula.It is the formation of hollow sac cavities throughout the intestinal wall.The outpouching sacs can form anywhere throughout the intestine but most commonly found in the sigmoid colon of the large intestine.

Risk factors

a. Age

More common in elderly population, but uncommon before the age 40.

As a person gets older, the pouches in the digestive tract become more prominent. The large intestine become weaker with the age and the pressure of the hard stool passing through the large intestine causes bulges to form.

b. Obesity

The link between obesity and chronic inflammation is believed to be obesity-related mechanisms which play a role in diverticulosis.

c. Food habits

• Low fiber diets

Due to low fiber diet, the stool become harder, smaller and drier and makes the intestines to work harder to push the stool through the system and out the anus.

Eventually certain areas of the intestinal wall start to herniate overtime.

• Red meat

Unprocessed red meat intake, was associated with an increased risk of diverticulosis

• High intake of nuts, seeds and popcorn also increases risk of diverticulosis.

d.Certain medications

Steroids, opioids and nonsteroidal anti-inflammatory drugs also act as risk factors of diverticulosis.

d. Other factors

Family history, male gender,lack of exercise smoking and alcoholism also contributes to the risk of diverticulosis.

Pathophysiology

• Commonly affects sigmoid colon
• Muscle tone is weakened in the intestinal wall resulting in sac-like out pouching or diverticulum.
• Clients who consume low fiber diets have hard stools that stay in the colon longer.
• These stools are harder to push out which increases pressure in the intestine and this leads to the stool getting stuck in the out-pouching.
• Stool getting stuck in the herniated pouches due to straining/constipation.
• The increased pressure in the colon causes a tear in the diverticulum which leads to infection and inflammation.
• This allows bacteria to migrate in the out-pouching and cause infection.

Treatment

High fiber, high residue, avoid foods with seeds

Iv therapy, hydration,saline lock.

Psylliiummix in 8 oz

Psyllium works by absorbing water from the intestine which in turns makes stool easier to pass (softer and bulker)

Probiotics

Probiotics may restore the balance of gut flora by decreasing pathogenic gram negative bacter

Antibiotics

Gentamicin, tobramycin,clindamycin to avoid infection

Anticholinergic drug reduces inflammation of the colon.

Drink plenty of fluids (2-3 L) to keep hydrated as tolerated softens the hard stool.

Semi fowlers position and isometric exercises al