Closed Case Friday: Intestinal Issues

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical 57-year-old patient has been experiencing pain in the lower left side of his abdomen and has had a persistent fever for several days. He is constipated and has been feeling nauseous, but has only actually vomited once this week. Our patient has been a smoker most of his life and his BMI is 35. He reports having a diet that is high in red meat and dairy and low in fiber and he does not recall the last time that he engaged in any vigorous exercise. He reports using Advil frequently to relieve joint pain. After conducting a physical examination, his physician orders a liver enzyme test and CT scan. The liver enzyme test is normal, but the CT scan confirms the physician's suspected diagnosis. The physician tells the patient to move to a liquid diet for a few days before gradually introducing solid foods. They have a conversation about gradually improving diet and exercise habits to avoid further complications that could require surgical intervention. She recommends that the patient stop taking Advil and use Tylenol as needed to manage pain.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Diverticulitis

In our hypothetical situation, the physician would have seen evidence of an uncomplicated form of diverticulitis on the CT scan that she ordered, which led her to create the treatment plan described above. Diverticulitis is caused by the inflammation of diverticula, which are small, bulging pouches that can form in the lining of the intestines. These often form in the lower parts of the intestines (such as the colon). Diverticula are common in patients over the age of 40 and don't cause problems unless they become inflamed. If they do become inflamed, patients experience severe abdominal pain, typically on the lower left side of the abdomen (though it is more commonly felt on the lower right side in Asian patients), along with fever, nausea, constipation, and sometimes vomiting.

Mild cases of diverticulitis are typically treated with rest, temporary movement to a liquid diet to allow the intestines to heal before gradually increasing solid food intake, and changes in regular diet and exercise habits. These cases can be accompanied by infection, which may additionally require antibiotic treatment.

In complicated cases of diverticulitis, infections can progress to abscesses or peritonitis, scarring can lead to intestinal blockage, or fistulas can form between sections of bowel. The severity of those kinds of complications can require intravenous antibiotics, draining of abscesses, or surgical interventions, which involve either primary bowel resection or a resection with colostomy.

This condition can be prevented by managing diet and exercise to lower the risk of developing diverticula. Regular exercise, eating enough fiber, refraining from smoking, and drinking enough water can all help to lower your risk of developing diverticulitis.

Thanks for joining us for this week's Mystery Case and we hope to see you next semester!