PGY黄建平医师临床教师林永章医师.pptVIP

PGY：黃建平醫師 臨床教師：林永章醫師 General data 姓名: 梁0達 性別: 男 生日: 48-05-10 (51 y/o) 病歷號: Chief complaint Progressive right lower quadrate epiagstric pain for 4 days Present illness relatively healthy previously RLQ pain for 3-4 days(一開始無法辨識痛的位置,後來感覺右下腹在痛), dull pain, intermittently, more severe when walking. denied vomiting and diarrhea Transfered from clinic. Medical history 1. DM: nil 2. HTN: nil 3. surgical: appendectomy in years ago  Personal history Alcohol drinking: denied Smoking: denied Drug abuse: denied Pet: denied Travel history at recent six months: denied PE Abdominal: Tender pain at RLQ with peritoneal sign Liver/spleen: impalpable Hyperactive bowel sounds No abdominal bruit, no psoas sign, no obsturator sign. No knocking pain Abd CT 1.In favor of diverticulitis in ascending colon and cecum. DDX epiploic appendagitis. 2.Left renal stone and renal cyst. Diverticulitis Diverticulitis is a common digestive disease particularly found in the large intestine. The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. Diagnosis The CT scan is very acurate (98%) in diagnosing diverticulitis. treatments An initial episode of acute diverticulitis is usually treated with bowel rest (i.e., nothing by mouth), IV fluid resuscitation, and broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis * *