Diverticulitis Essay

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.

Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.

This patient presented to the emergency department (ED) with pain in his upper right quadrant and flank. He reported experiencing abdominal distention

Wilcox (2009) compared various types of diverticular syndromes and their treatments. He found out that the treatment for the asymptomatic that is characterized by no clinical symptoms and symptomatic which has no inflammation but abdominal pain with change in bowel habits are high-fiber diet. Marinella (2010) found that for uncomplicated diverticulitis, with fever and abdominal pain can be treated with oral antibiotics, bowel rest, clear liquid diet and total abstinence from morphine because morphine has the risk of intracolonic pressure increased. This type of uncomplicated diverticulitis is for a young stable patient. For an older patient with uncomplicated diverticularitis, IV antibiotics should be administered but nothing by mouth.

Diverticulitis can most typically be attributed to low-fiber diets and chronic constipation. Factors such as aging, lack of regular exercise, high-fat intake, and physical abnormalities may contribute to the disease (NDDIC 2007). Epidemiological and anatomical evidence indicates that more than 60% of Westernized societies will develop diverticulosis at some point (Escott-Stump 2007). This is stark contrast to Asian societies follow more high-fiber, low-total fat and low-red meat dietary patterns (Nguyen et al. 2011). It is believed that high body mass index and obesity are predisposing factors.

On the same date an abdominal x-ray was also completed which revealed no small bowel dilation, no free gas, with a few small pelvis phleboliths (venous calcifications) noted. My involvement and care of the patient occurred Feb 22nd. On this date her lab work was: BUN 6.3, Cr 64, Na 138, K+ 3.5, Cl 107, C02 22, WBC 8.2 (15.4 Feb 15, 4.1 Feb 17), Hgb 93 (106 Feb 15, 80 Feb 16, 73 Feb 17), Hct .291, Plts 305. On assessment the client was still on contact plus isolation, but both a stool C+S and C-Diff tests were negative. Vitals: T 35.8, P 68 reg, RR 18, BP 94/52, Spo2 98% room air, Pain 0/10 (did receive 650mg acetaminophen @ 0630 for chronic Lt arm/hand pain).

In February, I was hospitalized for 4 days due to Meckel's Diverticulitis. For several months prior to this, I had trouble eating certain foods and experienced excruciating stomach pain. My doctors were stumped trying to figure out what was wrong with me. We tried diet changes and a variety of medicine, but nothing worked. After many consultations, my doctor decided to schedule an exploratory surgical procedure. Unfortunately, the date for my scheduled procedure did not come soon enough.

of abdominal pain and bleeding per rectum since 3 months. On examination he had diffuse

The patient is 69-year-old gentleman who presents to the ED complaining of rectal bleeding which has been present for about the past week. He claims past for large amount of bloody stool in the ED. His stool is guaiac is positive. There is no evidence of hemorrhoids. Work up in the ED reveals him as an abdominal CAT scan to have cholelithiasis but no acute cholecystitis. There is a cystic-appearing structure within the proximal pancreatic body and some colonic diverticular disease and he has a large right inguinal hernia with multiple nondilated loops of small bowel, nonobstructive. There is some mild elevation of his troponin therefore he was admitted acutely inpatient. Hemoglobin and hematocrit are stable and remained stable. I discussed

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

The pattern was unremarkable without any ulcerations, edema, or colitis. ______ polyps were identified. Left-sided diverticula identified but no evidence of any active diverticulitis. Scope was then retroflexed into the rectum internal hemorrhoids were identified as well as what appeared to be two distal rectal polyps and then the scope was then withdrawn. Once this is done a bivalve anoscope was introduced and all anal crypts were inspected no evidence of any fissures were noted; however, in the posterior midline patient was noted to have an anal fistula. A probe was introduced into this and then the fistula itself was then opened. The base of it was then cauterized and once this was done, the defect was then closed primarily using a running interlocking suture of 2-0 Vicryl. Internal hemorrhoids were identified in the right and left anterior positions and these were ligated using a rubber band ligator. The patient was also noted to have two distal rectal polyps, one noted in the anterior position as well as one noted in the

Diverticulitis is a common clinical problem and the complications represent one of the commonest surgical emergencies with a high and increasing prevalence in Western Societies.[ , ] An estimated 10-25% of the population younger than 60 years of age show evidence of colonic diverticula on colonoscopy, rising to 60% of those over 60 years.[ , , ] Although only 5% of patients with diverticulosis will develop acute diverticulitis, around 25% of patients will experience symptoms.[ ] Younger males are known to suffer more severe complications from diverticular disease as the case we presented.[ ] The majority of episodes are treated as outpatients with antibiotics; however it is reported that acute diverticulitis and its complications are responsible for 50,000 emergency hospital admissions per year in the UK with mortality of around 5%.[ ]

The second phase of the disease involves the bacteria entering the immune tissue of the small intestine. This causes vomiting and diarrhea, often described as "pea soup." If left untreated, the bacteria can create a hole in the small intestine, causing intestinal matter to flood the abdominal area. If one is lucky enough to survive this illness without treatment, he or she can still be a carrier of the germs long after the symptoms have disappeared.

A 35 year old African-American male with a past medical history of hepatic hemangioma and borderline hypertension presented with a one-week of intermittent fevers and progressively worsening sharp right upper quadrant abdominal pain. Associated symptoms are chills, night sweats and fatigue. He denied any recent sick contacts, recent travel or changes in his water source. He denied weight loss, cough, nausea, vomiting, chest pain, shortness of breath, dysuria, hematuria, headache, changes in stool, blurry vision, and no joint pain. Patient endorsed decreased in appetite,