Diverticulitis Case Study

History of Present Illness: Patient presents with complaints of nausea and abdominal pain that is occurring two or three times a week. She reports that she has been having this pain for four months. Patient states pain is around the umbilicus area and then around her entire stomach. She reports the pain usually lasts one to two hours then goes away. She reports sometimes the pain is accompanied by nausea but not always. Reports occasional belching. She reports the pain occurs at different times. It occurs when she eats and when her stomach is empty. Patient reports that an empty stomach seems to be when she notices the pain the most. She has tried to take TUMS but has not been successful swallowing the TUMS due to the chalky taste when

The patient you are evaluating is a 28-year-old male experiencing lower abdominal discomfort and frequent diarrhea (more than 15 bowel movements per day). He reports he has previously experienced episodes of loose stools but it seems to be getting worse. He also reports having lost 15 pounds in the past month. Both of ulcerative colitis and Crohn's Disease have many but because The colonoscopy reveals inflammation in the rectum, sigmoid colon, ascending colon, and ileum. ulcerative colitis is the chronic inflammation of the large intestine or colon. Crohn's disease commonly affects the area where the small intestine (ileum) joins the colon. Also, the symptoms of Crohn's include diarrhea that occurs for more than 6 weeks, abdominal pain and

Diverticulitis is inflammation of one or more diverticula located within the intestine. This condition results when the diverticula (small out pouches in the colon) become swollen and perforate through the mucosal and serosal layers of the intestine (Nettina, 2014). This inflammation leads to bacterial overgrowth and ischemia which further complicates the condition Signs and symptoms for diverticulitis include: left lower quadrant pain, low-grade fever, urinary frequency, dysuria, peritonitis with abdominal rigidity, and abdominal distention (Ignatavicius, 2013). Management for the condition depends on the severity. If the symptoms are mild to moderate, treatment can be done in an outpatient setting with use of broad-spectrum antibiotics. When deep perforation has occurred, as with this patient, surgical management is required to resection the diseased area of the colon (Nettina, 2014). Depending upon the type of colon resection, a colostomy is also considered.

This is a 37-year-old, Afro-American male who I am meeting for the first time. He has intermittent left lower quadrant pain over the last four years, currently this pain comes and goes. No identified precipitant and it seems to go away on its own. He denies any diarrhea, constipation, nausea, vomiting, or weight loss. He was previously diagnosed with Crohn's disease but those records are not available for my review. He is on no medications for Crohn's disease at this time. He has a history of hypertension and takes hydrochlorothiazide.

CT of the abdomen and pelvis with contrast dated 10/15/2014 showed diffuse sigmoid colon diverticulosis without evidence of diverticulitis.

Patient F.C. is a 63-year-old African American male, who presents to the emergency department with intense left upper quadrant pain that radiates to his back and under his left shoulder blade; stating, “It feels like I have a knife in my stomach”. He reports the upper abdominal pain is intermittent, onset 3 weeks ago; however, the pain has been increasing in severity for the past four days. He states “he has been feeling very warm with episodes of nausea for the past 4 days” with a noted an 8-10 pound weight loss in the past 45 days. He denies any diarrhea or blood in his stool; however, he notes a reduction in the frequency of his bowel movements.

The intestines consist of a long, flexible tube that is coiled around, so it appears to be smaller than it actually is. In a healthy person, it is smooth inside and out, so waste can move through it easily since the large intestines are the last stop before waste passes on its way out of the body. But as a person ages, there are pouches that begin to form in the large intestines. This condition is called diverticulosis. The bulges make passing waste more difficult, so sometimes, it gets caught in them or irritates them. When the pouches become inflamed and infected, it is referred to as diverticulitis. This condition can be very painful. It causes constipation, abdominal pain, a low grade fever, and nausea. The symptoms can last for just a few days or for several weeks. And once someone gets the condition, it is often something that they struggle with on and off for years if they don't treat it properly.

The most likely diagnosis for this severe abdominal pain located within her right lower quadrant and amongst her right side would be an acute appendicitis due to inflammation of the appendix.

However, both conditions—Ulcerative colitis and Crohn’s disease can be diagnosed by performing the following: health history, physical and mental assessment in combination with several diagnostic investigations. Throughout these assessments, gathered is patient clinical history such as lifestyle, prescription drugs, recreational drugs, diet, smoking status, bowel movements, and appearance of the faeces, family history, vomiting; and nausea. Diagnostic procedures and test are: endoscopy, colonoscopy, barium enema, CT scan, MRI. In addition, biochemistry tests are performed such as: faecal sample examination, full blood count, iron studies, inflammatory markers and special antibodies test. Computer tomography in procedure used to diagnose diverticulitis, during an acute episode, barium enema, endoscopy or colonoscopy to diagnose diverticulosis. (Digestive Health Foundation, 2013).

I watched a laparoscopic sigmoid colectomy performed to treat a perforation in the large intestines caused by chronic diverticulitis at Sacred Heart Hospital. Diverticula are small pockets that form in the intestinal wall, typically in the sigmoid and descending colon. In the patient I observed, the diverticula of the sigmoid colon had become infected and ruptured, perforating, putting a hole in, the large intestine. The patient had severe left lower quadrant pain that radiated across the abdomen, exacerbated by palpation. The infection and perforation resulted in peritonitis, or the inflammation of the abdominal wall, which caused this tenderness. Without surgical intervention, the patient would likely have died. After waiting for a

Colonoscopy lead to the discovery of diverticula in the colon. It is suspected that they ruptured and lead to on and off, self-resolving gastrointestinal bleed. Which would account for the patient’s dark stools, decreased H&H, nausea, and weakness.

Diverticulosis remains asymptomatic in most cases. In few cases, the diverticulitis occur. The process is discussed by Van Buren and Fisher (2017) as follow: feces will fill the diverticulosis and provides an environment that facilitate bacterial overgrowth. These result irritations which can cause inflammation or microperforations, which lead to infection and abscess formation by allowing bacteria invasive the colonic wall. The diverticulitis can be complicated or uncomplicated. Uncomplicated diverticulitis characterized by local infection and inflammations. If the localized infection or abscess infiltrates into adjacent organs or viscera or cause obstruction, it is considered complicated diverticulitis. The typical bacterial involved are

Abdomen Assessment – The patient’s abdomen does not display any striae, scars, prominent veins, or spider nevi. It is flat with no bulging, and the umbilicus is midline and inverted. There is no pulsating above the umbilicus. Bowel sounds are active x4. No heard bruits over the abdominal areas. There is no complaints of pain upon percussion of the abdomen. Tympany is heard over the abdomen, and dullness is heard over the liver. Patient feels pain with fist percussion on the right flank. She also expresses discomfort in the lower abdominal quadrants upon palpations.

Diverticulitis occurs when, for unknown reasons, a diverticulum, usually in the left colon, bursts, leaking bacteria-rich feces into the peritoneum. The resulting diverticulitis is usually confined to the surface of the adjacent colon, producing an acute illness characterized by severe abdominal pain in the left lower part of the abdomen, fever, and prostration. The treatment usually consists of fluids, bed rest, and antibiotics. Some cases require hospital admission[1].

You are absolutely correct that if teeth are missing mastication would not happen and choking would occur. Also, teeth aid in the mechanical breakdown of food into smaller pieces so that digestion is easier is on the body. I notice that you did not go in depth with a digestive disorder so I though I could provide one. I family member of mine was recently diagnosed with diverticulitis. Diverticulitis is where pouches form in the colon and become inflamed or infected causing abdominal pain, fever or loss of appetite. Luckily, her diet has changed to a high fiber diet and she hasn't had any pain.