특수간호실습 CASE STUDY: A0 받은 장게실염 간호과정 보고서

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1. Diverticular disease

대장 게실은 대장벽의 일부가 비정상적으로 탈출된 주머니이고, 게실 질환은 합병증이나 통증이 동반된 경우이다. 대개 아무런 증상이 없기 때문에 대장 내시경검사나 대장 조영술 중 우연히 발견되는 경우가 많다. 게실에 염증이 생기면 열, 복통, 복막자극 증상 등이 나타나게 되며, 염증이 생기면서 변비 증상이 생길 수도 있다. 대변에 피가 섞여 나오는 현상은 4명 중 1명에서 나타난다. 그러나 드물게 대량 출혈이 발생하는 경우도 있다. 진단을 위한 검사로는 대장내시경, 대장조영술, 복부 CT, 복부 초음파 등이 있다. 초기 아무런 증상이 없다면 특별한 치료는 필요하지 않으며, 섬유질이 많은 음식과 수분을 섭취하여 대변을 부드럽게 하고, 변비가 오래가지 않도록 잘 관리해주는 것이 중요하다. 출혈 등의 증상이 나타나는 경우 수술적 치료가 필요할 수 있다.
2. Diverticular bleeding

게실 출혈의 경우 보통 무통성 출혈이며 3~5%의 환자에서 심한 출혈을 보인다. 20%의 환자에서 게실염이 동반될 수 있고, 우측상행결장에 호발한다. 위험 요인으로는 고혈압, 동맥경화, NSAIDs 복용 등이 있다. 출혈 시 수술적 치료를 시행하는 경우는 출혈의 지속과 반복으로 혈역학적으로 불안정한 경우, 24시간 내에 6pint 이상의 수혈이 필요한 경우이다. 출혈 부위를 확인할 수 있는 경우 선택적 절제술을 시행하고, 확인하지 못한 경우 아전결장적출술을 시행한다.

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1. Diverticular disease

Diverticular disease is a common gastrointestinal condition that affects the large intestine, particularly the colon. It occurs when small pouches, called diverticula, form in the lining of the intestine and bulge outward through weak spots in the colon wall. While many people with diverticular disease may not experience any symptoms, some can develop complications such as diverticulitis, which is the inflammation or infection of the diverticula. Symptoms of diverticulitis can include abdominal pain, fever, nausea, and changes in bowel habits. The exact cause of diverticular disease is not fully understood, but it is believed to be related to a low-fiber diet, lack of physical activity, and increased pressure within the colon. Risk factors include older age, obesity, and certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids. Management of diverticular disease typically involves dietary changes, such as increasing fiber intake, and sometimes medication to reduce inflammation or prevent complications. In severe cases, surgery may be necessary to remove the affected portion of the colon. Preventive measures, such as maintaining a healthy lifestyle and diet, can help reduce the risk of developing diverticular disease or its complications.
2. Diverticular bleeding

Diverticular bleeding is a complication of diverticular disease, where the small pouches or diverticula in the colon rupture and cause bleeding. This type of bleeding can be a serious medical condition, as it can lead to significant blood loss and potentially life-threatening complications. The main symptom of diverticular bleeding is the sudden onset of bright red or maroon-colored rectal bleeding, which can range from mild to severe. In some cases, the bleeding may be intermittent or stop on its own, but it can also be persistent and require medical intervention. The underlying cause of diverticular bleeding is not fully understood, but it is believed to be related to the weakening of the blood vessels in the diverticula, which can rupture and bleed. Risk factors for diverticular bleeding include older age, use of certain medications (such as NSAIDs or anticoagulants), and the presence of other medical conditions that can affect the colon, such as inflammatory bowel disease. Treatment for diverticular bleeding typically involves a combination of measures, such as fluid resuscitation, medication to control bleeding, and, in some cases, endoscopic or surgical interventions to identify and stop the bleeding source. In severe cases, hospitalization may be necessary to monitor the patient's condition and provide appropriate treatment. Prevention of diverticular bleeding involves managing the underlying diverticular disease through dietary changes, such as increasing fiber intake, and maintaining a healthy lifestyle. Regular check-ups with a healthcare provider can also help identify and address any risk factors for diverticular bleeding.