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Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis.
Both are a form of diverticular disease. Diverticula are colonic mucosa that herniate through the smooth muscles in the large intestinal tract. They form because of increased collagen and elastin deposition contributing to the increased intestinal wall pressure and herniation associated with intestinal wall thickening. A person can have these diverticula herniations and be asymptomatic. (McCance et al, 2009). This is defined as diverticulosis. When a person has these diverticula pouches and they become inflamed from an underlying reason this is defined as diverticulitis. Underlying factors that put the person at risk are older age, genetic predisposition, obesity, smoking, diet, sedentary lifestyle, and the use of certain medications, such as, aspirin and NSAIDs. (McCance et al, 2019).
Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.
Older age was discussed earlier as a risk factor. The patient is 84 years old. The patient has a history of diverticular disease, which puts her at risk for inflammation of the disease. The patient is having left lower quadrant pain. In Western countries the left colon is the most common site for diverticulitis. (McCance et al, 2019). The abdomen is distended as well, which can indicate increased intraluminal pressure. An indicator for diverticulitis is alterations in intestinal motility. (Matrana et al, 2009). The patient is having constipation with nausea and vomiting. Clinical findings that point to the patient having diverticulitis is the low-grade fever, increased abdominal discomfort, hypotension at 90/60, and tachycardia at 101 beats/min.
List 3 risk factors for acute diverticulitis.
Three risk factors are older age, smoking, and diet. (McCance et al 2019).
Discuss why antibiotics and IV fluids are indicated in this case.
Antibiotics are indicated for this patient because of the possible sepsis criteria that the patient meets per most facilities. The patient is febrile with a temperature of 101.2. The patient is tachycardiac with a heart rate of 101 beats/min. The patient is also hypotensive with a blood pressure of 90/60. The patient is having left lower quadrant pain which can indicate advanced abdominal infection. The patient’s vitals can be a result of dehydration, but the patient reports sudden onset of symptoms over 1 day. As a provider it will be acceptable to treat the patient with antibiotics and fluids and allow for bowel rest with help from analgesics.
References:
Matrana, M. R., & Margolin, D. A. (2009). Epidemiology and pathophysiology of diverticular disease. Clinics in colon and rectal surgery, 22(3), 141–146. https://doi.org/10.1055/s-0029-1236157
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.

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