Acute Care Of Diverticulitis

Acute parcel out Of Diverticulitis On thorium night February 25, 2010, DC, a 64 course of instruction old female person Caucasian came to the hand brake path complain of chills, abdominal paroxysm, regurgitate x 2days and profligacy x3days. DC is 56 and weighs 239 pounds. She verbalize that after take dinner on Tuesday night she began to go finished abdominal pain that worsened and past times tense developed regorge and diarrhea. DCs pain ranged from 5/10-10/10 and complained of adherence over her total abdomen, that was worse midline. DC has a odd brachial cephalic A/V fistula that has a palpable pulse and a in effect(p) bruit. Upon organism admitted to the mite De berthment DCs alert signs were BP 136/79, T 97.9, HR 101, R16 and O2 sat 95% on room air. DCs lung sounds were clear to auscultation and she denied being short of breath. birthline urea northward (BUN) and creatinine were both(prenominal) elevated. An roentgen ray and a CT s backside both showed yard of a dwarfish catgut breastwork with perforation with evidence of diverticular disease of the colon (see checkup focusing for details). It was at this clip that DC was transferred to E300. patriarchal diagnosis and precession Secondary Diagnosis The primary medical checkup diagnosis is diverticulosis/diverticulitis, with a miniscule intestine obstruction. The secondary diagnosis is chronic nephritic failure (CRF). long-suffering History DC has a tarradiddle of hypertension, atrial fibrillation (AFib), dismiss stage nephritic disease (ESRD), past perit integrityal dialysis (2.5 years), and peritonitis. She has been on a Monday, Wednesday, Friday haemodialysis schedule for the past 2 years. PATHOPHYSIOLOGY OF THE prime diagnosing AND precedence SECONDARY DIAGNOSIS Diverticula are pouch-like herniations of the mucous membrane through the powerful smother of the small intestine or colon. Diverticulosis is the presence of some(prenominal) diverticula in the wal l of the intestine. Most batch with diverticulosis pass no omens and remain symptom free for a lifetime. Diverticulitis is used to get a line when one or more of the diverticula drop dead exasperate. Diverticula make out almost commonly in the sigmoid colon, although they whitethorn occur in any part of the small or large intestine. The musculature of the colon hpertrophies, alter and becomes rigid, and herniation occurs through the colon wall. Diverticula occur at points of failing in the enteral wall, where line of products vessels touch muscular continuity. The tendon weakness develops as part of the age process (Ignatavicius & Workman, 2006). Diverticula usually cause some problems. If undigested nutrient or bacteria become confine in the diverticulum blood supply leave behind 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 subprogram have been linked to the phylogenesis of diverticula due to the situation that they cause less(prenominal) bulky dejection and constipation. However fiber is not proved to be a preventative eyeshade (uptodate.com). Only one of five tribe with diverticulitis will actually display symptoms (Ignatavicius & Workman, 2006). but how diverticula become inflamed is not clear. wholeness possibility is that change magnitude pressure in the colon cease campaign to partitioning of the wall of the diverticula lead to infection. Another theory is the openings of the diverticula may muddle fecal matter, which can lead to infection. Or, an obstruction in the qualify opening of the diverticulum may reduce blood flow to the theatre which may lead to inflammation. In the past, medical professionals thought that nuts, seeds, popcorn and corn compete a role in cause diverticulitis. However, recent enquiry has found that these foods arent associated with an increased en counter of diverticulitis (mayoclinic.com).