1 / 18

Diverticulitis

Diverticulitis. Identifying Data. R.T. 53 years old Male Filipino Employee High school graduate Roman Catholic Pasig City Reliability 80%. Chief Complaint. Left lower quadrant abdominal pain “ Pabalik-balik ang ‘ sakit ’ ng tiyan ko . ”. history. History.

alpha
Télécharger la présentation

Diverticulitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diverticulitis

  2. Identifying Data • R.T. • 53 years old • Male • Filipino • Employee • High school graduate • Roman Catholic • Pasig City • Reliability 80%

  3. Chief Complaint Left lower quadrant abdominal pain • “Pabalik-balikang ‘sakit’ ngtiyanko.”

  4. history

  5. History • Usual bowel movement: 2-3x daily, well-formed stools, after meals • Gradually developing abdominal pain, “kinakabag” colicky, LLQ, no precipitating signs or symptoms, starts prior to defecation, relieved with defecation, 7/10 • (-) fever, nausea, vomiting, hematuria, dysuria, acholic stools, hematochezia • Recurrent consults at company clinic/ E.R. • Meds: Motilium or Dysplatil • Temporarily relieved 2 years PTA 

  6. History • Sensation of recurrence of symptoms • Self-medicated Dysplatil TID w/ complete relief 1 year PTA 

  7. History 2 months PTA  • Acute onset abdominal pain, colicky, LLQ, precipitated by inability to pass flatus, unrelieved with defecation, radiating to hypogastric area, 10/10, no specific timing, continuous • (+) nausea (-) fever, vomiting, hematuria, dysuria, acholic stools, hematochezia • CT scan: Diverticulitis • Meds for 2 weeks w/ complete relief • Ciprofloxacin 500mg/tab BID • Metronidazole 500mg/tab TID

  8. History 1 month PTA  • Recurrence of symptoms • (+) Tea-colored urine (-) fever, vomiting, dysuria, retention, trickling, flank pain • CT: suggests stone in ureter • Resumed medications w/ temporary relief • (+) Ciprofloxacin,Metronidazole 1week PTA  • CT scan abdomen: no change in diagnoses • AP advised admission ADMISSION

  9. Review of Systems • General. (+) Weight loss, weakness (-) Fever, fatigue • Musculoskeletal/ Dermatologic. (-) Rashes, change in skin color, lesions, joint swelling/ tenderness, gout • HEENT. (-) Dizziness, headache, blurring of vision, tinnitus, deafness, aural discharge, itchiness, earfulness, nosebleeds, frequent colds, hoarseness, enlarged LN • Respiratory. (-)Cough, dyspnea, hemoptysis, wheezing

  10. Review of Systems • Cardiovascular. (-) Chest pain, palpitations, orthopnea, syncope • Gastrointestinal.(+) Poor appetite (-) Nausea, dysphagia, heartburn, change in bowel habits, rectal bleed, jaundice • Genitourinary. (-) Frequency, nocturia, dysuria, hematuria • Endocrine. (-) Excess sweat, polyuria, easy fatigability, easy bruisability, heat/cold intolerance • Extremities. (-) Edema

  11. Past Medical History • GERD (1975) – Kremil-S • No history of asthma, allergies, HTN, DM, Pneumonia, Tuberculosis, Thyroid problems, or Trauma • Cannot recall immunization history

  12. Family History • (+) Hypertension, Diabetes, Stroke, Lung cancer • No known history of Asthma, Allergies, Pneumonia, Tuberculosis, Kidney or Liver disease • No other family member presenting with the same symptoms or complaint

  13. Personal and Social History • High school graduate • Machine operator, drug manufacturing • Non-smoker • Non-alcohol drinker • Denies illicit drug use/abuse • Diet: mainly on fish and vegetables • No regular exercise

  14. Upon recent admission Physical examination

  15. Physical Examination • General: Awake, alert, coherent, ambulatory, not in cardiorespiratory distress • Vital Signs:120/80, 81, 21, 36.6°C, Ht: 154cm, Wt: 52 kg, BMI: 21.5(normal range) • Skin: fair color, no rashes, lesions, no clubbing/pitting fingernails, • HEENT:anicteric sclera, pink palpebral conjunctiva, 2-3mm pupil BRTL, EOMs full and equal, non-sunken, no aural/otic discharge, no TPC, moist buccal mucosa, no CLAD, flat neck veins

  16. Physical Examination • Respiratory: full, equal chest expansion, clear breath sounds, no rales/rhonchi/wheezes • Cardio: adynamicprecordium, apex 5th ICS LMCL, NRRR, distinct S1/S2, no murmurs • Abdomen: flat, soft, no lesions/ scars, hypoactive bowel sounds, no abdominal bruit, tympanic in all quadrants, direct tenderness 3-4/10 RUQ, no rebound, no guarding, no organomegaly (+) Rovsings, Obturator, Psoas(?) • Extremities: warm, full equal pulses, CRT <2secs, no edema

  17. Salient Features

  18. Diverticulitis

More Related