Diverticulosis

Etiology:
Diverticulosis is believed to be caused by a low fiber diet leading to chronic constipation and resulting in increased colonic pressure which causes herniation of the colon wall (diverticula). If these diverticula become inflamed or infected, the condition is called diverticulitis. (Ann Redwine)

Signs/Symptoms:
Usually asymptomatic. Sometimes lower GI pain, especially on the left side of the abdomine and sometimes mild bleeding or blood in the stool. (A. Redwine)

Method of Diagnosis:
Doctor may order tests if patient has pain in the lower left side of the abdomine, history of constipation, or blood in stool. Any one of the following tests can be used to diagnose diverticulosis: colonoscopy, CT scan, barium enema or sigmoidoscopy. (A. Redwine)

Risk Factors:
*Modifiable: Low fiber diet, lack of exercise (A. Redwine)
*Non-Modifiable:
Risk increases with age (A. Redwine)

Prevention:
Diet adequate in fiber and fluid and exercise to increase colonic motility. Dietary Guidelines for Americans recommends 14 g fiber for every 1000 kcal consumed. (A. Redwine)

Supplements Commonly Used:
Methylcellulose and psyllium fiber supplements (A. Redwine)

**Labs Appropriate to Disease:
WBC count is normal in diverticulosis but an elevated WBC may indicate diverticulitis.
Anemia may occur due to lower GI bleeding. Hematocrit and Hemoglobin may be low. (A. Redwine)

*Normal Values Range:
WBC = 5 x 10(3)/mm(3) to 10 x 10 (3)/mm(3)
Hematocrit = 42-52% (men) and 35-47% (women)
Hemoglobin = 14-17 g/dl (men) and 12-15 g/dl (women) (A. Redwine)

*Values in the Disease:
WBC normal in diverticulosis.
WBC> 10 x 10(3)/mm(3) may indicate diverticulitis. WBC=15 x 10(3)/mm(3) is common in diverticulitis.
Hgb < 12 in women and Hgb < 14 in men.
Hct <35% for women and Hct < 42% in men with lower GI bleeding. (A. Redwine)

*Nutritional Significance:**
The goal of nutrition therapy is to decrease intralumenal pressure and promote easier laxation. Obesity and Decreased physical activity. Dietary fiber contributes to both fecal bulk and a decreased stool transit time. Most people in the United States consume inadequate fiber when compared with other populations. National Health and Nutrition Examination Survey data indicate that average U.S. fiber consumption is 13 g to 15 g per day, which is approximately 50% of the current recommended intake. (J. Lee)

General Dietary Prescription:
It is generally accepted that a high-fiber nutrition therapy, with 6-10 g beyond the standard recommendations of 25-35 g/day is recommended for diverticulosis. Add fiber to diet gradually to ensure tolerances. Slowly begin restricted-fiber/low-residue nutrition therapy until inflammation and bleeding are no longer a risk. Consider addition of probiotic food such as yogurt or kefir to daily diet. Assure adequate fluid intake and begin oral intake with clear liquids. Avoidance of nuts, seeds, and hulls has been historically recommended. Nil per os with bowel rest until bleeding and diarrhea resolve. (J. Lee)

Specific Foods to Include:
Choose fresh fruit and vegetables instead of juices. Choose whole grain breads, such as 100% whole wheat, rye, and bran. Choose cereals made from whole grains, such as wheat, bran, or oats. Have brown rice or wild rice instead of white rice or potatoes. Check food labels for the Nutrition Facts panel. This will list the grams of dietary fiber per serving. You can compare the amounts for similar foods and then choose the one with the most fiber. The best choices have at least 5 g fiber per serving. (J. Lee)

Specific Foods to Avoid:
Historically, your doctor or registered dietitian may have recommended to avoid nuts and seeds. Recent research suggests that this may not be necessary. (J. Lee)

Recomended Prescription Drug Therapy:
Anti-biotic pill form and intravenous Anti-biotic, colon surgery or colostomy (J. Lee)

Potential Food and Drug Interactions:
You should avoid drink orange juice, milk, certain vitamins and minerals (depending of type of antibiotic: zinc, vitamin K, vitamin C, iron, and etc.), alcohol, and caffeine. It depends on the antibiotic your doctor decides to prescribe you, many different antibiotics can be used to correct this disease, make sure to talk to your pharmacist about any drug and food interactions for that specific type of antibiotic. (J. Lee)

General Nutrition Education Objectives or Goals:
The patients should be educated on proper diet including fluid intakes, high-fiber intakes and proper vitamin/mineral nutrition that is best found in foods. They should be tolled to make regular check up to make sure they are living a proper and nutritional lifestyle. They should be instructed on regular physical activity and how this can prevent/reduce the chance of this recurrence. They should go over a dietary prescription, specific foods to eat and not to eat, and the potential food/drug interactions that can occur. (J. Lee)

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