Course
NR 507 Advanced Pathophysiology
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 … with acute diverticulitis and she is … to the hospital. She is … intravenous antibiotics and fluids (IVF). Her symptoms … and she could tolerate a regular diet before she was discharged to home.
Discussion Questions:
- Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and
- Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.
- List 3 risk factors for acute diverticulitis.
- Discuss why antibiotics and IV fluids are indicated in this case…..
SOLUTION
1. Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis
Diverticular disease (or diverticulosis) is defined as the presence of diverticula, which are herniations or saclike protrusions in the colonic wall whereas diverticulitis is defined as an inflammation of the diverticulum with acute diverticulitis is considered to be inflammation in the diverticulum and colonic wall due to microperforation of a diverticulum (Ellison, 2018). The cause of diverticular disease is unknown, however, several predisposing factors have been identified that include older age, genetic predisposition, obesity, smoking, diet, lack of physical activity, and medication use such as aspirin and nonsteroidal anti-inflammatory drugs (McCance & Huether, 2019). Diverticula can be found anywhere in the gastrointestinal tract but are most commonly found in the left colon (for Western countries) and the right colon (for Asian countries) and rarely occur in the small intestines (McCance & Huether, 2019). Diverticula form where there are weak points in the colon wall, typically where the arteries penetrate the tunica muscularis in order to nourish the mucosal layer which allows the colonic mucosa to herniate through the smooth muscle layer (McCance & Huether, 2019). A common finding in patients with diverticulitis is a thickening of the circular and longitudinal muscles surrounding the diverticula that is conducive to an environment with increased intraluminal pressure and encourages herniation of the colonic mucosal layer which falls in line with Laplace’s Law that postulates that as wall pressure increases in a cylindrical structure the diameter of said structure………please click the purchase button below to access the entire solution at $15