Do U Know The Dx?

[Ahmed Al-Kaisy]

A 60-year-old man presents to the ED with a 1-day history of left-sided abdominal pain. He has had several loose brown stools, but denies any nausea or vomiting; additionally, he reports feeling febrile, sweaty, and generally fatigued. The abdominal exam reveals tenderness and guarding; the digital rectal exam shows tenderness on the left side of the rectal vault.

what is most probable diagnosis?

[ali al-kafaji]

could it be diverticulosis?!

[Free Lancer]

I Think It Is Crohns Disease ...

[Ahmed Al-Kaisy]

Good morning guys...
The most probable Dx would be acute diverticulitis...

Dear Ali, diverticulosis is the persence one more than one diverticulae and wont give us such a history, while diverticulitis is the inflammation of one or more diverticulae...

dear ahmed, crohn's disease commonly affect the right side of colon and small intestine....

thanks 4 ur answers...

Now, how would u manage such patient with acute diverticulits?

[ali al-kafaji]

but dose not diverticulitis develop from diverticulosis!!!
thanks dr. for the case i hope u keep on the good work....
ali

[kenzo]

management:
DDX
The differential diagnosis includes colon cancer, inflammatory bowel disease, ischemic colitis, and irritable bowel syndrome, as well as a number of urological and gynecological processes. Some patients report bleeding from the rectum.

Patients with the above symptoms are commonly studied with a computed tomography, or CT scan. The CT scan is very sensitive (98%) in diagnosing diverticulitis. In order to extract the most information possible about the patient's condition, thin section (5mm) transverse images are obtained through the entire abdomen and pelvis after the patient has been administered oral and intravascular contrast. Images reveal localized thickening and hyperemia (increased blood flow) involving a segment of the colon wall, with inflammatory changes extending into the fatty tissues surrounding the colon. The diagnosis of acute diverticulitis is made confidently when the involved segment contains diverticulae. CT may also identify patients with more complicated diverticulitis, such as those with an associated abscess. It may even allow for radiologically guided drainage of an associated abscess, sparing a patient from immediate surgical intervention.

Other studies, such as barium enema and colonoscopy are contraindicated in the acute phase of diverticulitis due to the risk of perforation.

treatment
An initial episode of acute diverticulitis is usually treated with conservative medical management, including bowel rest (ie, nothing by mouth), IV fluid resuscitation, and broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis.

Upon discharge patients may be placed on a low residue diet. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are placed on a high-fiber diet. There is some evidence this lowers the recurrence rate.

In some cases surgery may be required to remove the area of the colon with the diverticula. Patients suffering their first attack of diverticulitis are typically not encouraged to undergo the surgery, unless the case is severe. Patients suffering repeated episodes may benefit from the surgery. In such cases the risks of complications from the diverticulitis outweigh the risks of complications from surgery.

Fortunately, for most cases, diverticulitis responds quickly and completely to antibiotics when administered quickly.

[Ahmed Al-Kaisy]

thanks dear for this wonderful answer....