Chapter 33 Flashcards
How would a patient with acute diverticulitis present in emergency room?
Mild fever, nausea vomiting left lower quadrant abdominal pain chronic constipation for 10 years
What is positive in the physical examination?
Tenderness and involuntary guarding in the left lower quadrant
What would necessitate this patient being hospitalized?
Nausea vomiting, not able to tolerate oral intake. Elderly patient, (others include high-grade fever, leukocytosis, immunosuppressed, lack of support system, significant comorbidities)
What should be initiated wow confirmatory test are pending?
Bowel rest and Empiric anabiotics
What has she ran for this patient?
CBC BMP LFT UA Blood culture, Abdominal CT
What is the differential diagnosis for left lower quadrant abdominal pain and fever?
Diverticulitis, Pyelonephritis, renal colic, colonic obstruction or perforation
What is it outpatient management as patient?
Diet: clear liquids until clinical improvement then advanced diet as tolerated
Empiric oral antibiotics: Cipro plus metronidazole, amoxicillin-clavulanate, Moxifloxacin
What is the treatment for inpatient management in a few diverticulitis?
NPO with IV hydration or clear liquids, IV Ampicillinsulbactam, piperacillin-tazobactam, IV ticarcillin-clavulanate
Combination drugs IV metronidazole or third generation or quinolone or aztreonam
When should patient switch to oral antibiotics? For how long?
After clinical improvement; Total course of 7 to 10 days PO antibiotic treatment, patient should improve within 2 to 3 days
When should patient start considering complications in the acute diverticulitis patient? What should be done?
After three days of antibiotics and lack of improvement; May require surgical intervention
What are the possible complications for this patient?
Peritonitis, perforation, obstruction, fistula, abscess
What is the counseling first patient?
High-fiber diet, medication compliance, medication side effects, regular exercise
When should empiric antibiotics be initiated in this patient?
After physical examination
What are the PO medications that patient should switch to?
PO metronidazole and PO ciprofloxacin And Percocet
What is the location for this patient?
ER, ward after positive CT scan, home after 24 hours of improvement
