bluestar
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A patient presents to ER with complaints of severe abdominal pain, fever and malaise. the patient has had chronic complaints of mild abdominal cramping and constipation, which became markedly worse several days before. On PE, temp 104 F and marked guarding and tenderness of abdominon, most markedly in the Left lower quadrant. Blood studies should WBC 22000/mm3 composed mainly of neutrophils and band forms. what's the diagnosis and patients's likely age?
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| mani
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meckel's diverticulitis
inflam superimposed on diverticulosis
perforation proximal to an obstructive lesion eg ca colon
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| Idiopathic
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This looks like typical diverticulitis ('left-sided appendicitis') more than likely in a male over 60.
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| bluestar
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"Idiopathic" wrote:
This looks like typical diverticulitis ('left-sided appendicitis') more than likely in a male over 60.
It's very likely that a diverticulitis is the criminal but how do we differentiate with other diseases that can also happen in the lower left quadrant? say, Crohn's disease, or like what mani said, perforation proximal to an obstructive lesion eg colon cancer? Meckel's diverticulitis would appear as abdominal pain in the periumbilical area that radiates to the right lower quadrant. Also, history of bleeding per rectum may be helpful in distinguishing this entity from appendicitis
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| Idiopathic
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You go by most commons. Most common cause of fever, left-shift leukocytosis and left-quadrant abdominal pain is diverticulitis. Given Hx of chronic constipation, it makes even more sense. Of course you will do rule-out studies, but it looks like diverticular disease to me, and I would work the patient up as such,
I would expect other signs with perforation, and would expect the phrase "
no bowel sounds were heard" or "tinkling bowel sounds" if obstruction were the culprit.
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| mani
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ok, ,i get it, thanx
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| bluestar
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me, too. thanks
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| mjl1717
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M.D. is a dx of exclusion/(similar presentation to appendicitis) usually in *RLQ* [omphalomesenteric duct doesnt involute]
rule of 2s- 2% of population
2% are symptomatic
usually before age 2
remnants are roughly 2 inches
2 ft from ileocecal valve
2 times as common in males
[developmental disorder] {Idiopathic already gave a clinical tip on how to rule out this possible small bowel obstruction but most are asymptomatic}
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