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Flashcards in Chapter 33 Deck (15)
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1
Q

How would a patient with acute diverticulitis present in emergency room?

A

Mild fever, nausea vomiting left lower quadrant abdominal pain chronic constipation for 10 years

2
Q

What is positive in the physical examination?

A

Tenderness and involuntary guarding in the left lower quadrant

3
Q

What would necessitate this patient being hospitalized?

A

Nausea vomiting, not able to tolerate oral intake. Elderly patient, (others include high-grade fever, leukocytosis, immunosuppressed, lack of support system, significant comorbidities)

4
Q

What should be initiated wow confirmatory test are pending?

A

Bowel rest and Empiric anabiotics

5
Q

What has she ran for this patient?

A

CBC BMP LFT UA Blood culture, Abdominal CT

6
Q

What is the differential diagnosis for left lower quadrant abdominal pain and fever?

A

Diverticulitis, Pyelonephritis, renal colic, colonic obstruction or perforation

7
Q

What is it outpatient management as patient?

A

Diet: clear liquids until clinical improvement then advanced diet as tolerated
Empiric oral antibiotics: Cipro plus metronidazole, amoxicillin-clavulanate, Moxifloxacin

8
Q

What is the treatment for inpatient management in a few diverticulitis?

A

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

9
Q

When should patient switch to oral antibiotics? For how long?

A

After clinical improvement; Total course of 7 to 10 days PO antibiotic treatment, patient should improve within 2 to 3 days

10
Q

When should patient start considering complications in the acute diverticulitis patient? What should be done?

A

After three days of antibiotics and lack of improvement; May require surgical intervention

11
Q

What are the possible complications for this patient?

A

Peritonitis, perforation, obstruction, fistula, abscess

12
Q

What is the counseling first patient?

A

High-fiber diet, medication compliance, medication side effects, regular exercise

13
Q

When should empiric antibiotics be initiated in this patient?

A

After physical examination

14
Q

What are the PO medications that patient should switch to?

A

PO metronidazole and PO ciprofloxacin And Percocet

15
Q

What is the location for this patient?

A

ER, ward after positive CT scan, home after 24 hours of improvement