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B.S. is an 81 year old Caucasian female presenting with abdominal pain, diarrhea, nausea and vomiting in the emergency room on February 3, 2013. B.S. has a history of glaucoma, hypothyroidism, degenerative arthritis and diverticulosis. She has allergies to iodine and vicodin. B.S. is admitted for diverticulitis with possible partial bowel obstruction and hydronephrosis. B.S. was admitted on February 3, 2013 here at Verdugo Hills Hospital.
Pathophysiology: Diverticulitis, is characterized by inflamed diverticuli and increased luminal pressures that cause erosion of the bowel wall and thus microscopic or macroscopic perforation into the peritoneum. A localized abscess develops when the body is able to wall off the area of perforation (Lewis, 2011, pp.1022-1029).
Hydronephrosis describes the situation where the urine collecting system of the kidney is dilated. This may be a normal variant or it may be due to an underlying illness or medical condition (Lewis, 2011, pp.1022-1029).
Diagnostic Tests and Procedures: On February 16, 2013 an abdominal x-ray with a small bowel through was done with contrast. February 11, 2013 a cysto right stent retrograde pyleogram was done in order to unblock a stone. CBC and blood cultures were drawn. Stool OB and UA were ordered as well.
Medical Management: Patient was seen by an E.R. doctor who decided not to start her on any antibiotics. Patient has been on 2 courses of Ciprofloxacin and Flagyl prior to admission. Blood work was drawn and abdominal x-ray ordered. Intravenous fluids were initiated in the emergency room to hydrate her as well to help the nausea. Urology consult was called for the patient. A stool study was also ordered down in the emergency room. She has had diarrhea for the past few days prior to admission. Clostridium difficile is a consideration due to the use of Cipro twice in the month of January. Zofran was ordered for her nausea, fluid

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