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Diverticulitis Case Study

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by

ALYSSA CHAVEZ

on 4 March 2014

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Transcript of Diverticulitis Case Study

Diverticulitis Case Study
Group F: Calvin Martin, Rachel Lindema, Sam Gwazdauskas, Julianna Davies, Alyssa Chavez, Austin Hampton, Amy Dhanani, Peppina Niemi, Heidi Davis
Patient History:
Previous conditions:
Hypertension diagnosis made 3 years ago
Medication:
Prinivil 5mg per day
Family History:
Mother had Cancer

Onset of disease:
Constipation on and off most of adult life
Recently developed episodes of diarrhea with LLQ pain
Complaint of blood expelled in bowel movement earlier in morning
Presented with two other episodes of bleeding in past 24 hours


Physical Exam
General appearance: slightly overweight 62-year- old African American women in no acute distress; somewhat anxious
Vitals: Temp 98.8*F, BP 120/82, HR 72 bpm, RR 15 bpm

Heart: S1 and S2 clear, no rub, gallop, or murmur, regular rate
HEENT: Unremarkable - normocephalic
Neurologic: ALert and oriented x4; strength 5/5 throughout, DTRs 2+ and symmetrical, sensation intact

Extremities: No edema
Skin: Warm, dry to touch
Chest/lungs: Clear to ausculation and percussion
Peripheral vascular: Peripheral pulses palpable

Abdomen: Positive bowel sounds throughout, nontender, nondistended


Investigation
NG aspirate heme negative
upper GI source of bleed ruled out
Colonoscopy negative for active bleeding
Numerous diverticula noted

Diagnosis
Diverticulitis!
with evidence of lower GI bleed in sigmoid colon.

What is Diverticulosis?
Small bulging sacs or pouches in the inner lining of the intestines.
Cause
dry, hard stools build up
when gut squeezes, it generates an increased pressure in the intestinal tract
may push inner lining of gut against muscle wall

What is Diverticulitis?
The bulging sacs have become inflamed and/or infected.
Mostly in the sigmoid colon (distal).
Cause
thickened feces get trapped in part of the diverticulum
rubs mucosa, causing inflammation and ischaemia colitis
ischaemia- restriction of blood supply to tissue
bacteria causes infection

Patient:

Name: Edna Meyer
Age: 62 years old
Height: 5’1
Weight: 155
Occupation: Works at home as a seamstress
Ethnicity: African American
Primary Complaint:
“ I had a lot of bright red blood in my bowel movement yesterday morning.”

Complications
Fistulas
caused by infected tissues forming together to create abnormal tunnels
Collection of abscess (pus)
Perforation in the wall of the bowel
Blood in bowel movement
bust of blood vessel
Fever
Nausea and vomiting

Risk Factors
Low fiber diets
"western diet"
Age
1/2 Americans by age 60 present with diverticula and 2/3 Americans over age 70
Low physical activity
Obesity
High total fat intake
The consumption of Alcohol & Smoking
Caffeine intake
Use of nonsteroidal anti-inflammatory drugs, cortico-steroids, and opiate analgesics
Gender- male

Treatment
Nutrition therapy
fiber intake
probiotics/prebiotics
Rest and possible use of heating pad and/or pain relievers for symptom relief
Antibiotics to treat the infection
Start NPO with bowel rest until symptoms subside
Drink only fluids for a couple days, slowly progressing to regular food
Complications may require surgery.
The pouches will be lifelong, however the infection/inflammation can be prevented


What Is She Eating?
24hr Recall
Diet Analysis
Vitamins & Minerals
Recommended Macronutrients
IBW: 105 lbs + or - 10.5 lbs
Percent IBW: 134%
BMI: 29.3
ABW is >120% of IBW, used IBW
BMR = 655.0955 + (9.5634 x 47.72 kg) + (1.8496 x 154.94 cm) – (4.6756 x 62 years)=1,108 kcal/d
25 kcal/kg x 47.7 kg= 1,192.5 kcal/d
Carbohydrate: 45 to 65%
Fat: 20 to 30%
Protein: 10 to 35%
For maintenance: 47.7kg x 1.5g/kg= 71.55g

Nutritional Therapy
-During flare ups, maintain a clear liquid diet
-Progress to low fiber foods
- Goal is high fiber diet of 21-25 grams
-Fluid intake no lower than 35 mL/kg/day
- Feed the gut!

Patient
Lab Values
Name: Edna Meyer
Age: 62 years old
Height: 5’1
Weight: 155
Occupation: Works at home as a seamstress
Ethnicity: African American
Primary Complaint:
“ I had a lot of bright red blood in my bowel movement yesterday morning.”
Examples of Foods
During liquid diet:
- Broth, juice with no pulp
Low Fiber Foods:
- Canned or cooked fruit without seeds or skin (applesauce)
- Dairy products, low fiber cereals, ground meat, pasta
High Fiber Foods
- Beans, legumes, whole grain bread and cereals,
brown and wild rice
- Fruits and Vegetables.
As Inflammation Decreases...
Patient can slowly resume a regular diet
Transition from clear liquids to low fiber diet
Decreased inflammation indicates adequate healing
Start by adding 5-15 grams of fiber to the diet

Medical Nutrition Therapy Goals
Slowly increase fiber to 21-25 grams per day
Increase soluble fiber by including apples, oatmeal, etc
Keep total fat intake to under 30% of total calories
Get plenty of liquids to help with increased fiber

Changing Edna’s Diet at Home

Edna's Banana Bread
Edna's Low Fat High Fiber Banana Bread
Recommended Fiber Supplements
Fiberall Oral
- To treat incomplete or infrequent bowel movements
- Irritable colon

Metamucil
- Multihealth fiber supplement
- Used to treat constipation


Ciprofloxacin
- Antibiotic class: fluoroquinolones
- 400 mg q 12 h
- Avoid: iron salts and antacids

Metronidazole:
- Treats infection caused by bacteria and fungi
- 1 g loading dose, then 500 mg q 6 h
- Take with food to decrease GI distress
- Avoid: alcohol

Prinivil:
- Treats hypertension and CHF
- ACE inhibitor
- 5 mg once a day
- Take with potassium supplements, aspirin or other NSAIDs

Medical Nutrition Therapy Goals
Slowly increase fiber to 21-25 grams per day
Increase soluble fiber by including apples, oatmeal, etc
Keep total fat intake to under 30% of total calories
Get plenty of liquids to help with increased fiber
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