A 57-year-old woman with a history of hypertension and hypercholesterolaemia presents to the

accident and emergency department with a 24-hour history of gradually worsening left-lower quadrant
abdominal pain associated with nausea and vomiting. Prior to this episode, the patient did not have any
significant gastrointestinal (GI) problems, except slight constipation and occasional dyspepsia after
heavy meals. She felt feverish but did not take her temperature. Her family history is negative for GI
disorders. also present with rectal bleeding.

1 What is the patient's diagnosis?...

Ans: Diverticulitis

2 Investigations to consider .

Ans: a. Blood tests: Complete blood count (CBC) to check for elevated white blood
cells (indicative of infection), electrolyte levels, and markers of inflammation.
b. Imaging studies:
• Abdominal CT scan: This is often the most useful imaging test to confirm the
diagnosis of diverticulitis and to assess the severity. It helps visualize
inflamed or infected diverticula, abscesses, and complications like
perforation.
• Ultrasound or MRI: These might be considered as alternatives in some cases,
although CT scans are more commonly used for diagnosis.

3 Treatment algorithm.

a. Mild Uncomplicated Diverticulitis:

• Antibiotics: If there's no evidence of severe infection or complications, oral
antibiotics may be prescribed to clear the infection. Commonly used
antibiotics might include ciprofloxacin and metronidazole or amoxicillin-
clavulanate.
• Clear liquid diet: Initially, patients might be advised to consume clear liquids
to allow the bowel to rest and recover.
• Pain management: Over-the-counter pain relievers may be recommended to
manage discomfort.
b. Severe or Complicated Diverticulitis:
• Hospitalization: In severe cases with complications like abscess formation,
peritonitis (infection of the abdominal cavity), or significant pain and fever,
hospitalization may be necessary.
• Intravenous antibiotics: Stronger antibiotics administered intravenously to
combat the infection.
• Possible drainage: If an abscess is present, drainage might be necessary,
either through CT-guided needle aspiration or surgical drainage.
• Bowel rest: NPO (nothing by mouth) initially to rest the bowels, followed by a
gradual transition to a liquid diet as tolerated.