Case Scenario:
An 84- year-old -female who has a history of diverticular disease presents to the clinic with left lower quadrant (LLQ) pain of the abdomen that is accompanied by with constipation, nausea, vomiting and a low-grade fever (100.20 F) for 1 day.
On physical exam the patient appears unwell. She has signs of dehydration (pale mucosa, poor skin turgor with mild hypotension [90/60 mm Hg] and tachycardia [101 bpm]). The remainder of her exam is normal except for her abdomen where the NP notes a distended, round contour. Bowel sounds a faint and very hypoactive. She is tender to light palpation of the LLQ but without rebound tenderness. There is hyper-resonance of her abdomen to percussion.
The following diagnostics reveal:
Stool for occult blood is positive.
Flat plate abdominal x-ray demonstrates a bowel-gas pattern consistent with an ileus.
Abdominal CT scan with contrast shows no evidence of a mass or abscess. Small bowel in distended.
Based on the clinical presentation, physical exam and diagnostic findings, the patient is diagnosed with acute diverticulitis and she is admitted to the hospital. She is prescribed intravenous antibiotics and fluids (IVF). Her symptoms improved and she could tolerate a regular diet before she was discharged to home.
Discussion Questions:
- Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.
- Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.
- List 3 risk factors for acute diverticulitis.
- Discuss why antibiotics and IV fluids are indicated in this case.
Solution:
Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis
Diverticulosis is the presence of tiny bulges or pockets (diverticula) in the colon. They do not cause symptoms hence no need for treatment. Diverticulosis can lead to diverticulitis. The pathological mechanism that leads to the formation of colonic diverticula remains unclear. However, it is believed that complex interaction between age, diet, genetic factors, colonic microbiota, and motility as well as the changes in colonic structure are involved in the development of this condition (Elisei, & Tursi, 2018). On the other hand, Diverticulitis is the inflammation or infection of one or more diverticula…..Click Icon below to purchase full tutorial at $10