WEEK 5- CASE STUDY

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Medicine

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Dec 6, 2023

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WEEK 5- Case Study (Gastrointestinal) 1. Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis. Diverticulosis occurs along any segment of the bowel but most commonly on the colon and presents as a pouch of colonic mucosa (Mohit et al., 2023). Due to loss of elasticity the colon wall becomes weak which results in the outpouchings along the layers of the mucosal and submucosal layers (Mohiet et al., 2023). Patients presenting with diverticulosis are generally asymptomatic until later in the phase where they present with diverticulitis (Tursi et al., 2020). Although the exact cause and ideology is unknown, those at risk include individuals with a low fiber intake, alcohol consumption, age, weight and pre- diabetic conditions put individuals at risk (Tursi et al., 2020). Diverticulitis is the complication of diverticulosis once abdominal pain has been identified, an inflammatory process is activated causing pericolic inflammation and is classified as uncomplicated or complicated (Severi et al., 2018). The degree of diverticulitis is associated with abscess, fistula, perforation and strictures that may be present (Young-Fadok., 2018). 2. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.

Clinical findings included left lower quadrant (LLQ) pain of the abdomen, constipation, nausea, vomiting, low grade fever (100.2 F) and positive occult blood. Altered bowel habits such as constipation along with findings of left lower quadrant pain, fever, and CT imaging are used to diagnosis Diverticulitis (Young- Fadok., 2018). 3. List 3 risk factors for acute diverticulitis. There are non-modifiable risk factors such as age, sex and genetics along with modifiable risk factors such as diet, physical activity, and prescription drugs (Tursi et al., 2020). Additional risk factors that have been linked to the predisposing of diverticulitis are smoking, read meat intake and NSAIDs (Severi et al., 2018). 4. Discuss why antibiotics and IV fluids are indicated in this case. The patient’s symptoms and labs indicated acute diverticulitis, as an inpatient standard management includes bowel rest. IV fluids were ordered for hydration due to pale mucosa, poor skin turgor and hypotension. IV antibiotics are ordered for inflammation and possible infection along with decreasing risks of complications and recurrence (Young-Fadok, 2018). Reference Bhatia, M., & Mattoo, A. (2023). Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends. Curēus (Palo Alto, CA) , 15 (8), e43158–e43158. https://doi.org/10.7759/cureus.43158

Young-Fadok. T. M. (2018). Diverticulitis. The New England Journal of Medicine , 379 (17), 1635–1642. https://doi.org/10.1056/NEJMcp1800468 Severi, C., Carabotti, M., Cicenia, A., Pallotta, L., & Annibale, B. (2018). Recent advances in understanding and managing diverticulitis. F1000 Research , 7 , 971–. https://doi.org/10.12688/f1000research.14299.1 Tursi, A., Scarpignato, C., Strate, L. L., Lanas, A., Kruis, W., Lahat, A., & Danese, S. (2020). Colonic diverticular disease. Nature Reviews. Disease Primers , 6 (1), 20– 20. https://doi.org/10.1038/s41572-020-0153-5 Moria, The differences in diverticular and diverticulitis were clear and concise. During my search for additional information on antibiotic use I also found mixed discussions on the use of antibiotic therapy. With further investigation I discovered antibiotic use for uncomplicated acute diverticulitis is subjective to the provider and the presenting symptoms (Mocanu et al., 2018). A meta-analysis revealed additional research needs to be completed in regard to antibiotic use with diverticulitis, although antibiotic use does account for less complications it does increase the patient’s length of hospital stay (Mocanu et al., 2018). This information may be helpful in future research studies related to antibiotic therapy with diverticulitis patients.

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Reference Mocanu, V., Dang, J. T., Switzer, N., Tavakoli, I., Tian, C., de Gara, C., Birch, D. W., & Karmali, S. (2018). The role of antibiotics in acute uncomplicated diverticulitis: A systematic review and meta-analysis. The American Journal of Surgery , 216 (3), 604–609. https://doi.org/10.1016/j.amjsurg.2018.01.039 LaKara, The risk factors that you shared for acute diverticulitis were very informative and the examples you provided also aligned with the ones I had found to be important. It’s pertinent to understand the risk factors when working with patients that need nutritional training or lifestyle modification. For example, with diverticulitis risk factors such as red meat and alcohol consumption can be easily modified once the patient is well aware of the risk factors (Liner & Sandor, 2018). Lastly, with obesity being a risk factor patients should be educated on prevention strategies such as increased physical activity (Liner & Sandor, 2018). Reference Liner, K., & Sandor, P. (2018). Changing theories on the pathogenesis and risk factors for diverticulitis. JAAPA (Montvale, N.J.) , 31 (10), 36–41. https://doi.org/10.1097/01.JAA.0000545069.63602.26

WEEK 5- CASE STUDY

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