Time Goes By So Fast

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.

On later reflection I realized I could have though about interstitial cystitis, appendicitis and renal calculi. My multiple hypotheses for this patient are presented in Table 1.

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.

The causes of diverticulitis are also thought to be due to internal pressure in the colon. It’s not completely understood what causes the diverticula to become inflamed and infected. The internal pressure of fecal matter in the diverticula can impair circulation; when circulation is reduced in the diverticula, the tissue can break down and sometimes the pouches can burst.

b) Place hand above right knee and ask pt to raise the leg to meet your hand. Pain may indicate appendicitis.

Diverticulitis is an aliment of the colon that affects the inner lining. Approximately 50% of all Americans will experience diverticulitis by the time they reach age 60. Pouches or bulging sacs in the lining become inflamed or infected. The most common site of diverticulitis is the large intestine. A low fiber diet is believed to be responsible for most cases of diverticulitis. Small pieces of feces can become trapped in the pouches and bulging sacs, which then cause the inflammation and/or infection.

Pathophysiology: Diverticulitis, is characterized by inflamed diverticuli and increased luminal pressures that cause erosion of the bowel wall and thus microscopic or macroscopic perforation into the peritoneum. A localized abscess develops when the

○ If there is blood in the abdomen, the surgeon will look for the source of the bleeding in order to stop it.

Patient might experience mild or sever pain, crampy, and aching that is similar to appendicitis. Passing of gas or stool elimination may reduce the adverse effect of pain. According to spivak & deSouza (2008), patient that are of high risk are those with the history of low-fiber diet, constipation, high intake of red meat, severe dehydration, and aging. The diagnostic tests are barium enema which determines number of diverticula, CBC indicates present of anemia, colonoscopy exposes present of diverticula, CT scan reveals changes in the colon wall, GI bleeding scan that identifies active bleeding, and CBC with differential reveals leukocytosis.

BIOLOGICAL MECHANISM: The condition of diverticulosis occurs when small areas of tissue form pouches in the large intestine or colon called diverticulum, or diverticula (plural). Diverticula may occur due to the lack of bulk forming and bacteria producing fiber, resulting in an imbalance of certain intestinal bacteria, increasing internal pressure on the intestinal tissue due to poor stool formation, constipation, or straining to pass stools. In the paper Low-Residue Diet in Diverticular Disease: Putting an End to a Myth it was stated that “fiber is an important energy substrate for the colonic epithelium because of its fermentation by colonic microbes to short-chain fatty acids, which in turn play a role in mucosal growth and colonic blood flow” (Tarleton, DiBaise 2011). Poor tissue health and increased internal pressure may cause the intestinal tissue to herniate causing diverticulum to form. Diverticulitis can occur when material or bacteria becoming trapped inside the diverticulum, and inflammation

Children ages 10-19 years are most commonly diagnosed with appendicitis. Appendicitis is often more difficult to diagnose in children than adults, because of this about 10-20 percent of kids with appendicitis will suffer from a perforated appendix before being treated. When the appendix is blocked, it becomes inflamed and bacteria can overgrow in it. Blockage can be due to stool, inflammation of lymph nodes in the intestines, or infections like parasites. A perforated appendix is one of the complications of acute appendicitis. If appendicitis is left untreated, ischemic necrosis of a portion of appendixes wall may occur, leading to perforation. This then allows the contents in the appendix to leak out into the rest of the abdomen, potentially causing other infections, such as septicemia. This can be a life threatening

Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation, and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects of the physical examination and had to be prompted by the MO. Although with more practice such incidence would be reduced.

Diverticular disease has two separate manifestations. The subtle signs and symptoms of diverticulosis are important to understand because many people who have this problem are asymptomatic, but often this diverticular disease can lead to a more serious condition known as diverticulitis. In diverticulosis, there are diverticula present, but they do not cause any symptoms. In diverticulitis, which will be discussed in detail, the diverticula are inflamed which can lead to other serious consequences for the patient (Gramse, 1983). Diverticulitis is a bugling protrusion of a mucous membrane through the wall of the colon (Marrs, 2006). These saclike or pouch protrusions have the potential to cause inflammation, obstruction, infection, and

In this study, out of 112 patients operated for acute non perforated appendicitis, 72 patients were male and 40 patients were female, a ratio of 1.8:1. The patients' age ranged from 18 to 55 years with a mean age of 26 years, the majority of cases lie in a range between 20-32 years. As shown in Table 1, there is no significant difference regarding patients' age, sex, medical comorbidities (diabetes, liver disease, renal disease, hyperlipidemia, heart disease), fever, leukocytosis, radiologic findings (appendiceal diameter, presence of free fluid) or operative time between the two groups.

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.