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Patient is a 66 years old male with complaint of abdominal pain on lower…
Patient is a 66 years old male with complaint of abdominal pain on lower left quadrant.
Admitting Dx: Diverticulitis
inflammation or infection of small pouches called diverticula
etiology of diverticular disease remains unknown
association with: low fiber intake, constipation, and obesity
risk factor: increasing age
an asymptomatic disease that develops overtime
fecal material or undigested food particles collects into divertula
causes obstruction
s/sx: lower abdomen pain, diarrhea, constipation, distension or flatulence, fever if inflamed, and tenderness
acute pain r/t inflammation of bowel aeb abdominal pain and diarrhea
hydrocodone (NORCAL 5) 5 mg/325 mg 1 Tab PO q4h PRN
morPHINE Inj 2mg IV q4h PRN if pain is 7-10 on pain scale
piperacillin/tazobactam 3.375 g in 0.9% NaCl 100 ml IVPB
Diverticula
small mucosal herniations
increases in intraluminal pressure in the weak points of the colon wall
arteries penetrates the tunica muscularis
occurs on the left sigmoid colon in Western countries
thickening of circular muscles and shortening of teniae coli surrounding diverticula
increased collagen and elastin deposition causes muscle thickening
increased intraluminal pressure and herniation
low-residue diet reduces fecal bulk thus reducing diameter of the colon
CT ABD pelvis with IV contrast and without oral contrast
sigmoid colon with diffuse mucosal thickening and pericolonic fatty stranding with small diverticula
No known medical history
active problems
risk factor: advance age
lower left quadrant pain
some tenderness
no bowel movements in the last 5 days before ER admit
NPO upon admission
advanced to clear liquid only
progressed to diarrhea after admission
diarrhea r/t increased intestinal motility caused by inflammation aeb pain and constant bathroom use
restless
temazepam cap 7.5 mg PO bedtime PRN
melatonin