Cause And Treatment Of Zenker's Diverticulitis
When a patient presents with unrelenting left lower quadrant pain, zenker's diverticulitis is just one of a host of problems that may be the Diverticulitis Cause. Massive rectal bleeding raises the possibility of a hemorrhaging diverticulum and the need for urgent evaluation by colonoscopy or angiography.
Instead of laying down a rigid high-fiber, low-fat dietary regimen, however, it may be preferable to advise the patient to truly modifying his or her diet by degrees. For example, a ban on excessively fatty foods would be untenable to a patient accustomed to red meat as an everyday staple and frying as a standard method of food preparation.
Instead, offer a list of low-fat foods, ask the patient which items on it he likes best, and suggest substituting these items for some of his usual high-fat choices. Once the person recognizes that eating sensibly does not mean a strictly programmed diet or total deprivation of highly pleasurable foods, change becomes a real probability. The same approach applies to reducing excessive sugar or caffeine intake and to breaking other potentially harmful eating and/or drinking habits.
If the patient is unwilling or unable to follow a diet reasonably high in fiber, then a fiber preparation may be necessary. Daily intake of any of a wide variety of psyllium seed products--Effersyllium, fiberall, metamucil, and so forth--will meet his needs. These products are either mixed with water first or require drinking water with or immediately after their use. An 8-oz glass of water with each dose is standard. It is important to emphasize the need for thorough chewing of foods: Large chunks of food that reach the colon undigested can start fecaliths and cause at least partial blockage. By chewing foods into fine particles, the patient can even eat foods not usually considered appropriate for people with diverticula. Although fruits with small, hard seeds are not good choices, peanuts, corn, and some fruit and vegetable skins, when they are properly chewed, would be. More commonly, fever, an elevated WBC count, and left lower quadrant tenderness in a patient over age 40 prompts hospitalization and a presumptive diagnosis of diverticulitis. Perforation is always a possibility and leaves no alternative to ready access to the surgical suite if the need arises. In the absence of specific indications for emergency surgery, medical management for 24 hours, then reassessment, is generally appropriate, especially if the patient has had previous similar attacks. On admission, getting a chest X-ray and plain and upright abdominal films is prudent. These may reveal evidence of colonic obstruction, a soft tissue mass, air bubbles outside the colon wall that suggest abscess, clues to inflammatory bowel disease, or ingested foreign bodies that have caused perforation. Any of these findings might obviate the need for difficult follow-up studies. With any patient hospitalized for suspected diverticulitis, some issues are crucial to review: * Is this likely to be something that will pass in a few hours, such as an attack of irritable bowel syndrome? * Is it suitable to treat this patient medically and observe for 24 hours? * Is this probably a surgical problem that can be safely pinpointed by procedures available in this hospital? * Are the indications for immediate surgery overriding? If the decision is to treat the patient medically, and he or she fails to improve within 24 hours, the final two questions must be addressed again.
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