Infections of the gastro-intestinal tract

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Diverticulitis

Case report:

A 76 year old patient appears in practice and complains of gradually resulting pain in the left lower abdomen, alternating with constipation, liquid stools and temperatures up to 38 C axillary.
These symptoms there for two days and occurred for the first time. Physical examination results in a significant pressure pain in the left lower abdomen without signs of peritonitis and a bit weak, but overall adequate bowel sounds. The rectal examination provides no abnormalities.

Diagnosis:

The patient's symptoms and the circumscribed tenderness in the left lower abdomen and febrile temperatures with irregular bowel movements indicate a diverticulitis. Since no severe disease is present and there is no suspicion of an abscess or peritonitis, an outpatient monitoring and treatment can take place. The blood count shows a slight leukocytosis with 11,000 leukocytes / ul of blood and a Hypersegmentation with 85% granulocytes without significant left shift; C-reactive protein is increased moderately with 20 mg / l.

Pathogenesis:

The diverticulosis of the colon in the elderly is the basis for existing here diverticulitis. In the acute phase must be assumed by an aerobic-anaerobic mixed infection with E. coli, Proteus species, enterococci and Bacteroides species and clostridia are to be considered as the causative agent.

Therapy:

Oral treatment with antibiotics, for example mitCiprofloxacin (Cipro) plus metronidazole (Clont among others), as well as ampicillin plus sulbactam (UNACID) or amoxicillin plus clavulanic acid (Augmentin) is possible. In addition, a mushy-liquid diet should be administered and reducing the motility antispasmodics should be given on the type of Butylscopolamins (Buscopan, among others). After completion of the acute disease, the patient should receive a fiber-rich diet and to undergo a colonoscopy to confirm the diagnosis or rule out other causes of the symptoms. The recurrence of diverticulitis is between 5-30%. Only in severe bouts with abscesses or perforations surgical intervention is indicated.

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