Gastrointestinal Nursing.pdf

82 Chapter 6Non-neoplastic polyps make up the vast majority of epithelial polyps foundin the large intestine (about 90%); these increase in frequency with age (Clarket al. 2000). Endoscopic removal of polyps (polypectomy) greatly reduces therisk of development of cancer.Colonic diverticulosisDefinitions related to colonic diverticulosis:• Diverticulum: an outpouching of the wall of the colon.• Diverticulosis: the presence of diverticula.• Diverticulitis: more than one diverticula are inflamed.• Diverticular disease: inflammed diverticula.Diverticular diseaseDiverticular disease is a general term which encompasses diverticulosis anddiverticulitis. Diverticular disease has a high prevalence in the Western world,affecting up to 50% of all adults over the age of 70 (Mortensen and Kettlewell2000). It is characterised by herniation at weak points on the intestinal mucosaand submucosa. A diverticulum typically has a narrow neck that contains allfour mucosal layers, and a spherical sac that contains intestinal serosa andmucosa only. Ninety-five per cent of diverticular disease patients have diverticulaof the sigmoid colon. Endoscopic presentation of diverticular disease isshown in Plate 6.Contributing factors for diverticular disease include:• hypertrophy (enlargement of tissue) of segments of the colon’s circularmuscle• age-related atrophy or weakness in the bowel muscles• increased intracolonic pressure• chronic constipation and straining• irregular, uncoordinated bowel contractions• lack of dietary fibre• obesityPossible complications of diverticular disease include ruptured or inflameddiverticulum; abcess formation around the diverticulum; oedema and spasmrelated to inflammation; erosion of an artery or vein; and colonic fibrosis andnarrowing.Treatment of mildly symptomatic diverticular disease usually involves thediet, most often in the form of a high-fibre diet, and the use of bulk-forminglaxatives to help maintain a regular, soft stool. In extreme acute attacks ofdiverticular disease, bed rest, antibiotics and analgesia may be required.