Differential Diagnosis I
Diverticulosis
A form of diverticular disease characterized by the formation of multiple, non-inflamed diverticula occurring in the descending and sigmoid colon. The diverticula are formed by muscular thickness and increased luminal pressure, accompanied with weakness in the colon wall.
Clinical Manifestations:
Figure 1: Diverticulosis and Diverticulitis (Mayo Foundation for Medical Education and Research, 2017)
Generally considered asymptomatic, but patient can present with symptoms, including, pain, mild cramps, and bloating or constipation. The major emphasis for differentiation is the presence of inflamed or microperforated diverticula, indicating diverticu
litis, or non-inflamed diverticula, indicating diverticulosis, upon diagnosis.
Rationale:
Mr. Smith, has been previously diagnosed with diverticulosis and his symptoms are consistent with those found in both diverticulosis and diverticulitis, thus the presence of diverticula mustbe determined in order to rule out one of the aforementioned diseases. Presence of diverticulitis may indicate progression of diverticulosis into diverticulitis.
Differential Diagnosis II
Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome is a poorly understood syndrome and the most common digestive disorder in the united states with a prevalence as high as 10% to 20% of the population. Newly diagnosed IBS is rare over age of 50 with fewer than one-third cases occurring in men. IBS runs in families, but the exact mechanisms is unknown. IBS people may have a GI tract that appears normal, colonic smooth muscle function if often abnormal. This abnormal function is due to failure of the autonomic nervous system to innervate the large colon producing excessive spasms and peristalsis and a subsequent disorder of GI motility.
Figure 2: Irritable Bowel Syndrome (Full Circle Health, 2017)
Clinical Manifestations:
During active IBS episodes patients can present with symptoms including left lower abdominal quadrant pain, fever, vomiting, cramping, diarrhea, flatus, constipation, bloating, and nausea. Both stress and intolerance for some foods can precipitate attacks. Complications with this disorder are unusual but can progress into diverticulitis.
Rationale:
Mr. Smith presents with symptoms found in IBS, but the patient’s age, sex, and lack of familial presence puts him at a lesser risk for diagnosis of IBS. To determine if his complications are IBS dependent it is important to determine whether the symptoms are associated with a disorder of GI motility with accompanying stress or food sensitivity
Differential Diagnosis III
Appendicitis
Appendicitis is an acute inflammation or obstruction of the vermiform appendix. Eventually bacteria accumulate, and the appendix can develop gangrene. Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdomen and the most common surgical emergency. Appendicitis in the elderly population is being reported with increasing frequency as life expectation increases.
Figure 3: Appendicitis (Mayo Foundation for Medical Education and Research, 2017)
Clinical Manifestations:
Patient presents with an inflamed appendix, typically at the right lower quadrant, which extends into surrounding tissues leading pain and fever, followed by nausea and vomiting. With subsequent serious complications, perforation, peritonitis, and abscess formation are possible.
Rationale:
Mr. Smith’s acute symptoms are consistent with what is found in appendicitis. Key characteristics of appendicitis are it’s location of pain, right lower quadrant, and accompanying rebound tenderness. Mr. Smith has been assessed to be negative for rebound tenderness, thus location of pain should be assessed in order to distinguish it from other gastrointestinal disorders, such as left lower abdominal quadrant pain found in diverticulitis. Additionally, due to it’s common occurrence and increasing prevalence in elderly patients, Mr. Smith’s risk is increased.