Case Study Diverticular Disease Health And Social Care Essay

The big catgut is abtaboo 1.5m in length and is made up of 4 brain parts the cecum, go uping colon, transverse colon, falling colon, sigmoid colon and the rectum. Its oral sex map is to transport waste out of the organic structure and to rent water system from the waste before it leaves. It is made up of three beds, the outmost bed muscularis, in-between bed the mucous membrane and innermost layer the mucous membrane. The mucous membrane is where all the re-absorption return keys topographic point whilst the muscularis is liable for peristaltic motions. Diverticular indisposition is most common in the sigmoid colon part. A diverticulum ( diverticulosis ) is a sacque like pouch which is formed from the mucous membrane and undertakings through the colon wall. This happens as a consequence of thither world a failing in the wall and at many diverticula puke show at any one clip. They ar besides vascular and present a rich blood supply. A failing in the wall dirty dog so be accompanied by an admission in persuasiveness per whole area of the intestine collect to the tolerant going cons pinchated. If there is a deficiency of role and H2O in the provender the makes become dry and minor, and the enteric musculuss must contract with gr run force to go through the stools along, bring forthing a naughtyer force per whole area in the big bowels. The extra force per unit area leads to weak musca volitanss in the colon walls that finally pouch out and organize pouches called diverticula. Most frequently, the pouches signifier in the sigmoid colon, which is the cut left designate of the colon that connects to the rectum. This country of the colon is capable to the highest entirety of force per unit area because it is the narrowest part of the big bowel ( E Health MD ) . Diverticula vary in size barely work to be between 5 -10mm and in extremes instances can make up to 20mm ( WGO ) .Diverticulitis is a status in which diverticuli in the colon rupt ure. The rupture consequences in infection in the tissues that surround the colon ( Medicinenet.com ) . Diverticular disease is many symptom little as mentioned earlier and many mint who have it are non eer aware that they have the status. Many patient ofs get a line symptoms similar to excitable intestine syndrome and quetch of bloating and hurting in the lower left abdominal muscle part. peerless of the most common causes of lower gastrointestinal hemorrhage is due to diverticular disease shed blooding which can happen because of the cutting of the bowel wall. The hemorrhage is by and large painless but does affect big volumes of blood ( Gastrointestinalatlas ) .Case purviewI have chosen my instance survey to be on a 45 twelvemonth old male who I will mention to as Mr X. I will be discoursing the patients chief symptoms, associated medical history, house stool history, trials and handling of jobs found.Mr X visited his G.P in January 2010 complaining of a crampy hurtin g over the left iliac pit. He besides complained of bloating and had non opened his bowels depennyly for a hebdomad. Mr X told the G.P that he had discover a alteration in his intestine habitude over the last 2 months and was sing episodes of irregularity which would be followed by short episodes of diarrhoea. He had besides noticed a alteration in the visual aspect of his stool explicating that they appeared to be smaller and had a crack like visual aspect. Coloring material of his stool was described as being common but he would detect a little off-keyish visual aspect every straight and once to a gr use uper extent. No history of emesis and he was eating and imbibing usually with the exception of sing a bloating esthesis after a repast. He besides complained of experiencing unenrgetic and did nt experience sooner every bit active as he was earlier. Mr X s critical marks were recorded BP 145/86, PR 88 and temperature 37.5. Apart for being nearlywhat pyrexic vital organs ma rks were normal for this patient. On scrutiny Mr X was found to be earlier dramatis personae in the lower left of his venters and on percussion there were transparent marks of difficult stool. Initial diagnosing made by the G.P was cranky intestine syndrome and irregularity caused by a hapless victuals. The G.P expressed reverence about Mr X complaining of his stool looking dark on a few occasions. The G.P advised the patient to imbibe plentifulness of H2O, growth fiber in his diet and to get down exerting on a regular basis to seek and convey his weight down.Mr X was tending(p) lactulose solution for his irregularity to be interpreted twice daily. The G.P asked the patient for a blood sample to govern out the disaster of anemia. Mr X was told a dark visual aspect of the stool may bespeak an top(prenominal) G.I bleed due to an ulcer but could besides be due to nutrient he had eaten. The fact that Mr X had a history of abeyance hernia meant that it should be investigated. M r X was asked to come back and see the G.P in a hebdomad s clip.Mr X has a history of high blood pressure and lower back hurting. He smokes 20 set nails a twenty-four hours and consumes 20 units of intoxicant a hebdomad. He is considered to be over weight at 18 rock and does non exert on a regular basis. His diet consists chiefly of satu placed nutrient he enjoys littlewave repasts and chows fast nutrient on a regular basis. Mr X works a security guard in the retail fabrication and works long displacements. He is married and has four kids. He is on Altace and lipid-lowering medicines for his high blood pressure and 20mg ezomeprazole for his suspension hernia. His male parent passed mop up from prostatic malignant neoplastic disease at the age of 78 and his female parent has history of lung malignant neoplastic disease.Mr X has taken over the counter medicines to seek and alleviate his irregularity with small consequence. He suffers with a moderate sum of emphasis and anxiousnes s due to his financial state of affairs but has no jobs go throughing piss. He has no loss of appetency and says he usually gets a good dark slumber. Apart from the job he is kicking of there is no different associated ailments.Mr X returned to his G.P a hebdomad after his first audience and was console kicking of the same job. The lactulose had small consequence but he even-tempered felt hurting and was stamp over his left iliac pit. An indwelling scrutiny concluded his stool still felt difficult. His observations were still clean much the same and his blood trial for anemia came back as normal. The G.P decided to mention Mr X for farther trials to set up the bring cause of Mr X s symptoms.Diagnostic ModalitiesOnce the G.P had refereed patients with symptoms similar to Mr X is common for them to hold a big intestine scrutiny called Barium enema. The patient is asked non to eat any solids 24 hours prior to the carry through and is give strong laxatives called picolax to ta ke ( London xray.com ) . With the usage of X raies the recreate runs Ba into the patient s intestine through a catheter surfacing the liner of the intestine. The intestine is distended utilizing an inflating expand and the patient is so moved about in different places whilst a series of epitomes are taken. The Ba is radiopaque which shows up the features of the intestine rather nicely. This type of scrutiny is besides peculiarly utile in governing body out other mathematical causes of the symptoms the patient has such as Crohn s disease or even a carcinoma. Barium enemas attractively shew diverticula and the mucous membrane of the big intestine. Below is an image taken from a Ba survey showing diverticular disease? A chiseled diverticulum can be seen in the Centre of the image.Figure 1 Library imageOther modes can be used to name diverticular disease such as colonoscopy and sigmoidoscopy but Ba enemas seem to be the favorite(a) pick of doctors. In an article called Barium cl yster versus colonoscopy the usage of these Scopess is compared to barium clyster and the advantage and disadvantages are mentioned. A colonoscopy and sigmoidoscppy is clip devouring and is authentically seldom completed under an hr. It can turn out rather painful for patients and sedation is required for the process. It is a desirable method for patients who complain of chronic hemorrhage which is overseen by Ba clyster. Barium clyster are normally painless no sedation is required and is completed normally within 10-15 proceedingss.A gastroscopy is a trial where the physician looks into the upper portion of the GI piece of land by infixing a thin plastic telescope called an endoscope down the gorge. The upper intestine consists of the gorge, tummy and duodenum. Gastroscopy is normally through with(p) as a twenty-four hours instance. The doctor may blunt the vertebral column of your pharynx by spraying on some local anesthetic. The patient can besides be given a ataractic if pr eferred. The tip of the endoscope contains a visible radiation and a bantam camera which allows the doctor to see inside the G.I piece of land. The endoscope besides has a side television channel which enables the doctor to go through assorted instruments which can be manipulated by the doctor for illustration to take biopsies. ( patient.co.uk ) . this process is a coveted expression of diagnosing Oesophagitis, Duodenal or tummy ulcers and gastritis. Figure 2 down the stairs shows a bleeding duodenal ulcer.Figure 2 ( image hkmas.org )If the patient complains of dark stool so there is a high possibility of there being a duodenal bleed or a bleed from the upper G.I piece of land. ( medlineplus )DiscussionAs mentioned before most of the instances of diverticular disease be given to be symptomless unless patients start to see alteration in there bowel wont. Normal stools which are big and soft transportation system rather easy and on a regular basis. A survey published in the Lancet volume 313 studies the prevalence of symptom less diverticular disease of the colon is related to the ingestion of dietetic fiber in vegetarians and non-vegetarians. Vegetarians had a significantly higher average fibers intake ( 41A5 g/day ) than non-vegetarians ( 21A4 g/day ) . Diverticular disease was commoner in non-vegetarians ( 33 % ) than in vegetarians ( 12 % ) . Comparison of topics with and without diverticular disease in the vegetarian and non-vegetarian groups provided some farther grounds that a low consumption of cereal fiber is associated with the presence of diverticular disease. These figures clearly show that a fibre deficient diet is linked to diverticular disease.Surveies show low fiber in the diet makes the stool harder and smaller doing irregularity, nevertheless a survey published in the British medical diary suggests every bit good as alleviating the symptoms of diverticular disease a high-fibre diet may besides forestall the status from developing. cardinal patients with diverticular disease treated with wheat bran 24g/day for at least sextuplet months. Thirty-three patients showed a really satisfactory clinical response. Sixty per cent of all symptoms were abolished, and a farther 28 % were relieved. After intervention the passage times accelerated in patients whose initial times were slower than 60 hours and slowed down in those whose initial theodolite times were faster than 36 hours. Stool weight change magnitude significantly. The figure of intracolonic high force per unit area moving ridges decreased, particularly during and after eating. Once once more overpowering grounds proposing a high consumption of fiber is of the essence(p) to keep off developing the disease.The Journal of clinical gastroenterology hypothesises that fibre lack non save leads to diverticula formation but besides causes a alteration in the micro ecology which consequences in reduced colon immune response and permits a low-grade chronic inflammatory p rocedure that precedes a matured chills and fever diverticulitis. However the hypothesis goes on to state that complications do non happen until there is micro-perforation through the wall of the diverticulum into the pericolic tissue which would take to abscesses and fistulous witherss being formed. In some instances, perforation of diverticulum becomes an acute medical exigency and requires immediate intercession. The mortality rate can be every bit high as 35 % ( Porrett & A Daniel 1999 ) .Treatment for diverticular disease does non be as such. Educating the patients about the possible hazards of a hapless diet is overriding. Physicians should promote patients to eat a diet high in fruit and veggies, with at least 2 liters of H2O a twenty-four hours. Patients should be encouraged exercising on a regular basis and to describe any reoccurrence of symptoms or rectal hemorrhage. Reoccurring symptoms or rectal hemorrhage will necessitate a referral for trials. Some passel live with chronic diverticular disease or IBS, which is closely related to diverticular disease. These people are advised to avoid cut down fatty nutrients and to avoid drinks incorporating caffeine and intoxicant ( WebMD ) .Treatment for acute diverticulitis requires an exigency colcetomy. In the past tense this type of surgery for diverticulitis was ever done as an unfastened process in which a big scratch was made in the venters. barely as laparoscopic surgery has become more popular, more sawboness are now utilizing this method for acute exigencies ( WebMD2 ) .ResultMr X was referred to the infirmary for a Ba clyster and gastroendoscopy due to him holding a history of a suspension hernia. The Ba clyster showed that Mr X had diverticulosis in his sigmoid colon. The adviser advised anti-spasmodic drugs for abdominal hurting in his study but suggested there was nt any call for for surgery. No other pathology was observed on the images.The images taken from the Gastroendoscopy showed no c hief(prenominal) pathology. There were some indicants of redness at the lower terminal of the esophagus proposing mild esophagitis. It was advised to increase the dosage of esomperzole from 20mg to 40mg if the patient presented with farther symptoms of indigestion. No marks of shed blooding or ulcers were observed.Since holding these trials Mr X has been sing the configuration dietician one time every two hebdomads. He has been given a diet to follow and his aim is to lose weight and eat a balanced diet. After talking to Mr X he tells me that he is eating plentifulness of fruit and veggies and wheaten staff of life. He had increased his fibre consumption and is besides imbibing plentifulness of H2O.He has noticed that he is non acquiring constipated every bit much as he used to be and opens his bowels more often. He has taken out a gym rank and has lost half a rock.Mr X will likely hold diverticular disease for the remainder of his life but every bit long as he lives by his unsan ded life style he will be able to master his symptoms and live a normal healthy life.A