A Case For Diverticulitis
A CASE FOR
DIVERTICULITIS
By:
What is
Diverticulitis?
What is Diverticulitis?
• Inflammation of small pouches, diverticula, within the mucosa of the colon
• Results in perforation of the peritoneum
• Can occur anywhere in the GI tract, but found mostly in descending colon
Signs and Symptoms
• Acute pain in the left lower quadrant • Palpable abdominal mass
• Systemic symptoms of infection – Fever
– ↑ c-reactive protein
– Leukocytosis with shift to the left
• *Can be asymptomatic
Case Study: Health History
• Patient: John Smith, a 60 year-old Caucasian male
• Past Medical History: Acute renal failure/insufficiency, hypertension.
• Allergies: NKA
• Social/Family History: Married and lives with his wife, who is in good health. He has three children who are grown and live in different states, but they talk daily.
• Reason for Admittance: Wife brought him to the hospital after complaints of severe pain in his abdomen. He was feeling nauseous for a few days prior to the pain, but started vomiting yesterday.
Case Study: Diagnostics
•
•
•
•
Abdominal CT Scan
CBC
CMP
Urinalysis
Diagnostics: Abdominal CT Scan
• Results of the CT scan show that the patient has acute diverticulitis with micro-perforation in the colon.
Diagnostics: CBC
Admission
(High/low/wnl)
Day of Care
(High/low/wnl
Reason for abnormality & Nursing
Implications
WBC
4.50-11.00k/mcL
15 k/mcL
6.52 k/mcL
Abnormal at admission due to diverticulitis.
RBC 3.505.50million/mcL
4.74 million/mcL
3.45 million/mcL
Low RBC due to perforation of diverticulitis.
Increase fluids and have patient rest.
Hgb
12.0-16.0g/dL
14.8 g/dL
11.0 g/dL
GI bleed due to diverticulitis. Increase fluids and supplement iron.
44.1 %
31.5 %
195 k/mcL
217 k/mcL
Hct
36.0-46.0%
Platelets
150-450k/mcL
Blood lose due to diverticulitis. Increase fluids. Diagnostics: CMP
121 mg/dL
104 mg/dL
137 mmol/L
139 mmol/L
4.1 mmol/L
3.4 mmol/L
9.0 mg/dL
7.4 mg/dL
26 mg/dL
14 mg/dL
DIVERTICULITIS
By:
What is
Diverticulitis?
What is Diverticulitis?
• Inflammation of small pouches, diverticula, within the mucosa of the colon
• Results in perforation of the peritoneum
• Can occur anywhere in the GI tract, but found mostly in descending colon
Signs and Symptoms
• Acute pain in the left lower quadrant • Palpable abdominal mass
• Systemic symptoms of infection – Fever
– ↑ c-reactive protein
– Leukocytosis with shift to the left
• *Can be asymptomatic
Case Study: Health History
• Patient: John Smith, a 60 year-old Caucasian male
• Past Medical History: Acute renal failure/insufficiency, hypertension.
• Allergies: NKA
• Social/Family History: Married and lives with his wife, who is in good health. He has three children who are grown and live in different states, but they talk daily.
• Reason for Admittance: Wife brought him to the hospital after complaints of severe pain in his abdomen. He was feeling nauseous for a few days prior to the pain, but started vomiting yesterday.
Case Study: Diagnostics
•
•
•
•
Abdominal CT Scan
CBC
CMP
Urinalysis
Diagnostics: Abdominal CT Scan
• Results of the CT scan show that the patient has acute diverticulitis with micro-perforation in the colon.
Diagnostics: CBC
Admission
(High/low/wnl)
Day of Care
(High/low/wnl
Reason for abnormality & Nursing
Implications
WBC
4.50-11.00k/mcL
15 k/mcL
6.52 k/mcL
Abnormal at admission due to diverticulitis.
RBC 3.505.50million/mcL
4.74 million/mcL
3.45 million/mcL
Low RBC due to perforation of diverticulitis.
Increase fluids and have patient rest.
Hgb
12.0-16.0g/dL
14.8 g/dL
11.0 g/dL
GI bleed due to diverticulitis. Increase fluids and supplement iron.
44.1 %
31.5 %
195 k/mcL
217 k/mcL
Hct
36.0-46.0%
Platelets
150-450k/mcL
Blood lose due to diverticulitis. Increase fluids. Diagnostics: CMP
121 mg/dL
104 mg/dL
137 mmol/L
139 mmol/L
4.1 mmol/L
3.4 mmol/L
9.0 mg/dL
7.4 mg/dL
26 mg/dL
14 mg/dL
References: Ambrosetti, P. P., Gervaz, P. P., & Fossung-Wiblishauser, A. A. (2012). Sigmoid diverticulitis in 2011: many questions; few answers. Colorectal Disease, 14(8), e439-e446. Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L. (2011). Medical-surgical nursing: assessment and management of clinical problems (9th ed.) (2012). Acute diverticulitis: demographic, clinical and laboratory features associated with surgery for complicated diverticular disease: a single-centre experience. Colorectal Disease, 14(10), 1248-1254