Diverticulosis vs Acute Diverticulitis: 84-Year-Old Female Case Study

1. Compare and contrast the pathophysiology of diverticular disease (diverticulosis) and acute diverticulitis. (CO1)

1. Identify risk factors for acute diverticulitis and the clinical signs and symptoms associated with the disease. (CO3)

1. Explain the significance of physical exam and diagnostic findings in the diagnosis of diverticular disease. (CO4)

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.

1. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.

1. List 3 risk factors for acute diverticulitis.

1. Discuss why antibiotics and IV fluids are indicated in this case.

1. Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.

Diverticular disease is characterized by small pouches in the large intestinal wall. These pouches are referred to as diverticular develop in the lining of the intestine and they result in low abdominal pain and a feeling of bloating. Diverticulosis is witnessed when people with diverticular do not exhibit any symptoms. Diverticulitis is a complication of diverticulosis and it is an infection that occurs when bacteria trapped inside one's body bulges hence triggering severe symptoms. The major signs and symptoms of diverticulitis are; constant and persistent pain at the lower left side of the abdomen, fever, vomiting and nausea, constipation, and abdominal tenderness (NHS Inform, 2023).

1. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.  

There are various clinical findings that support the patient's diagnosis of acute diverticulitis. The patient reports a history of diverticular disease with symptoms of abdominal pain accompanied by a low-grade fever of 100.20F for 1 day, vomiting, nausea, and constipation. Subjective findings indicated that the patient has an abdominal CT scan with no evidence of abscess and distended small bowel, a bowel-gas pattern consistent with an ileus as demonstrated by the flat plate abdominal x-ray, and positive occult blood for stool.

1. List 3 risk factors for acute diverticulitis.

Some of the three risk factors for acute diverticulitis are not exercising more frequently, taking [Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)](https://www.everydayhealth.com/nsaid/guide/) or corticosteroids, and the presence of polycystic kidney disease. Engagement in physical activities is associated with loss of weight and faster transit of stool through the colon. Exercises are associated with cardiorespiratory fitness and this reduces the risk of diverticulitis. [Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)](https://www.everydayhealth.com/nsaid/guide/) or corticosteroids cause injuries in the gastrointestinal tract and this eventually leads to diverticulitis (Sahli et al., 2022). Diverticulitis and diverticular diseases are common among people with polycystic kidney disease.

1. Discuss why antibiotics and IV fluids are indicated in this case.

The IV fluids and antibiotics are indicated in the case study as the patient is not required to take anything by mouth. This is essential in ensuring that the patients are ready for further testing and it will allow bowel rest. IV fluids are essential as the patient is exhibiting signs of dehydration which are; tachycardia, mild hypotension, poor skin turgor, and pale mucosa and requires to be hydrated. On the other hand, antibiotics such as rifaximin and fragyl are common in treating gastrointestinal infections such as diverticulitis (Piccin et al., 2023).

References

NHS Inform. (2023). Diverticular disease and diverticulitis. https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diverticular-disease-and-diverticulitis/#:~:text=Diverticular%20disease%20is%20caused%20by,with%20not%20eating%20enough%20fibre

Piccin, A., Gulotta, M., di Bella, S., Martingano, P., Crocè, L. S., & Giuffrè, M. (2023). Diverticular Disease and Rifaximin: An Evidence-Based Review. Antibiotics, 12(3), 443. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10044695/#:~:text=One%20study%20found%20that%20a,found%20that%20rifaximin%20(400%20mg

Sahli, H., Azhar, N., Lydrup, M. L., Jörgren, F., Schultz, J., & Buchwald, P. (2022). Risk factors for recurrence and complications in acute uncomplicated diverticulitis: A retrospective cohort study. International Journal of Surgery Open, 43, 100471. https://www.sciencedirect.com/science/article/pii/S2405857222000341#sec1