The correct answer is A. This patient most likely has diverticulitis, an inflamed herniation of the mucosa of the colon through the muscular layer of the bowel wall. The best way to diagnose diverticulitis is with an abdominal CT scan. The appropriate management of this patient is admission to the hospital. She should be kept NPO and given IV antibiotics.
Mild cases of diverticulitis may be treated as an outpatient with a clear liquid diet and PO antibiotics (choice B). However, this patient is too sick to be discharged and ought to be treated with IV antibiotics.
A colonoscopy (choice C) is useful to diagnose diverticulosis, but would not be used during an acute attack of diverticulitis because of risk of perforation.
Indications for urgent surgical intervention include abscess formation, severe disease, or confirmed perforation. This patient does not yet show signs of needing surgical intervention (choice D).
Abdominal pain is often the presenting sign of cardiac ischemia. However, this patient has few risk factors, no EKG changes, and does have abdominal exam findings. Therefore, cardiac catheterization (choice E) would not be indicated. You should, however, still continue to monitor her cardiac function and obtain cardiac enzymes.
|