A 76-year-old patient presents to the emergency department with severe left lower quadrant abdominal pain, diarrhea, and fever
On physical examination, you note the patient has a positive heel strike, and left lower abdominal rebound tenderness. These are typical signs and symptoms of which of the following conditions?
A. Diverticulitis
B. Salpingitis
C. Inflammatory bowel disease
D. Irritable bowel syndrome
ANS: A
Diverticular disease is prevalent in patients over 60 years of age. Since the sigmoid colon has the smallest diameter of any portion of the colon, it is the most common site for the development of diverticula. Although the pain can be generalized, it is typically localized to the left lower abdomen and is accompanied by tenderness, fever, and leukocytosis. Other symptoms can include constipation or loose stools, nausea, vomiting, and positive stool occult blood. With diverticulitis, there is an increased risk of perforation, which presents with a more dramatic clinical picture as a result of peritonitis. Look for signs of peritonitis, such as a positive heel strike test and/or rebound tenderness.
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