Diverticulitis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍LLQleft flankabdominal pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Location is ‍left lower quadrantdiffuse

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingsharp

Pattern ‍constantintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍fever, up to ‍°, over ‍ ‍hoursdays

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍constipation

‍diarrhea, ‍ episodes ‍per day, ‍

‍bloating

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍dysuria

‍frequency

‍hematuria



Contributing factors:

‍low-fiber diet

‍obesity

no history of: ‍diverticulitis, ‍diverticulosis, ‍abdominal surgeries, ‍kidney stones





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Diverticulitis ‍likelysuspectedpossible

DDx: diverticulitis, perforation, abscess, peritonitis, functional abdominal pain, abdominal wall strain, constipation, irritable bowel syndrome, inflammatory bowel disease, colorectal cancer, ischemic colitis, gastroenteritis, appendicitis, peptic ulcer disease, kidney stone, urinary tract infection, ovarian cyst, ectopic pregnancy, mesenteric ischemia, small bowel obstruction, celiac disease, food intolerances, lactose intolerance, medication-induced symptoms





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍LFTs, ‍ß-hCG

- CT scan of abdomen could be optional if diagnosis is clear and symptoms are mild

- Urinalysis, urine culture

- Abdominal ultrasound

- Colonoscopy

Treatments:

- ‍Antibiotics

- ‍Analgesics

- Clear liquid diet until symptoms improve

- Gradual reintroduction of fiber into diet

- Increase fluid intake

Further care:

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever, vomiting, or increased pain

- Referral to ER if severe abdominal pain, severe vomiting, or fever occurs