Acute Care Of Diverticulitis

Acute Care Of Diverticulitis On Thursday night February 25, 2010, DC, a 64 year old female Caucasian came to the emergency room complaining of chills, abdominal pain, vomiting x 2days and diarrhea x3days. DC is 5’6†³ and weighs 239 pounds. She stated that after eating dinner on Tuesday night she began to feel abdominal pain that worsened and then developed vomiting and diarrhea. DC’s pain ranged from 5/10-10/10 and complained of tenderness over her entire abdomen, that was worse midline. DC has a left brachial cephalic A/V fistula that has a palpable thrill and a good bruit. Upon being admitted to the Emergency Department DC’s vital signs were BP 136/79, T 97.9, HR 101, R16 and O2 sat 95% on room air. DC’s lung sounds were clear to auscultation and she denied being short of breath. Blood urea nitrogen (BUN) and creatinine were both elevated. An x-ray and a CT scan both showed evidence of a small bowel obstruction with perforation with evidence of diverticular disease of the colo n (see medical management for details). It was at this time that DC was transferred to E300. Primary Diagnosis and Priority Secondary Diagnosis The primary medical diagnosis is diverticulosis/diverticulitis, with a small bowel obstruction. The secondary diagnosis is chronic renal failure (CRF). Patient History DC has a history of hypertension, atrial fibrillation (AFib), end stage renal disease (ESRD), past peritoneal dialysis (2.5 years), and peritonitis. She has been on a Monday, Wednesday, Friday hemodialysis schedule for the past 2 years. PATHOPHYSIOLOGY OF THE PRIMARY DIAGNOSIS AND PRIORITY SECONDARY DIAGNOSIS Diverticula are pouch-like herniations of the mucosa through the muscular wall of the small intestine or colon. Diverticulosis is the presence of many diverticula in the wall of the intestine. Most people with diverticulosis have no symptoms and remain symptom free for a lifetime. Diverticulitis is used to describe when one or more of the diverticula become inflamed. Dive rticula occur most commonly in the sigmoid colon, although they may occur in any part of the small or large intestine. The musculature of the colon hpertrophies, thicken and becomes rigid, and herniation occurs through the colon wall. Diverticula occur at points of weakness in the intestinal wall, where blood vessels interrupt muscular continuity. The muscle weakness develops as part of the aging process (Ignatavicius & Workman, 2006). Diverticula usually cause few problems. If undigested food or bacteria become trapped in the diverticulum blood supply will diminish and bacteria invade the diverticulum. Diverticulitis occurs when the diverticulum perforates and a local absess forms (Ignatavicius & Workman, 2006). Diets with small amounts of fiber have been linked to the development of diverticula due to the fact that they cause less bulky stool and constipation. However fiber is not proven to be a preventative measure (uptodate.com). Only one of five people with diverticulitis will actually display symptoms (Ignatavicius & Workman, 2006). Exactly how diverticula become inflamed is not clear. One theory is that increased pressure in the colon can lead to breakdown of the wall of the diverticula leading to infection. Another theory is the openings of the diverticula may trap fecal matter, which can lead to infection. Or, an obstruction in the narrow opening of the diverticulum may reduce blood flow to the area which may lead to inflammation. In the past, medical professionals thought that nuts, seeds, popcorn and corn played a role in causing diverticulitis. However, recent research has found that these foods aren’t associated with an increased risk of diverticulitis (mayoclinic.com).