Requirements:

  1. Read the case study below.
  2. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
  3. Respond to at least one peer and all faculty questions directed at you, using appropriate resources, before Sun., 11:59 pm MT.

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:

  1. Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.
  2. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.  
  3. List 3 risk factors for acute diverticulitis.
  4. 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 in the colon. The bulges may not result in clinical features; hence treatment may not be necessary. However, there is an increased risk of diverticulosis resulting in diverticulitis. Diverticulitis is the inflammation and infection of the diverticula, which results in pain, nausea, and fever. The exact pathophysiology of diverticulosis is not known, although there are several theories that try to explain the pathophysiology of the disease. For instance, there are some theories that speculate that diverticulosis results from some abnormalities in peristalsis, intestinal dyskinesis, and high pressures in the intraluminal segments of the gut (Schieffer et al., 2018). The most common site of the diverticula is the mesenteric border, and the diverticula are true when they have all the layers of the intestinal wall, while the false diverticula result from the herniation of the mucosal and submucosal layers. The risk factors that can result in the development of diverticula are a low fiber diet, increasing age, and some diseases like systemic sclerosis….Kindly click the purchase icon to purchase the full solution at $10

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