A 76-year-old woman with chronic constipation reports a 4-day history of “achy” left lower quadrant.

A 76-year-old woman with chronic constipation reports a
4-day history of “achy” left lower quadrant abdominal pain, graded 7/10,
accompanied by low-grade fever and nausea. A colonoscopy performed 2 years ago
revealed sigmoid diverticular disease. On examination, she has a temperature of
38.6°C. Her abdomen has a tender 3 × 2 cm mass in the left lower quadrant.
Bowel sounds are normal. Her stool is positive for occult blood. An abdominal
series shows a bowel gas pattern consistent with ileus and no evidence of free
peritoneal air. A CT scan with contrast of the abdomen and pelvis shows
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A 76-year-old woman with chronic constipation reports a
4-day history of “achy” left lower quadrant abdominal pain, graded 7/10,
accompanied by low-grade fever and nausea. A colonoscopy performed 2 years ago
revealed sigmoid diverticular disease. On examination, she has a temperature of
38.6°C. Her abdomen has a tender 3 × 2 cm mass in the left lower quadrant.
Bowel sounds are normal. Her stool is positive for occult blood. An abdominal
series shows a bowel gas pattern consistent with ileus and no evidence of free
peritoneal air. A CT scan with contrast of the abdomen and pelvis shows
pericolonic fat stranding with no evidence of an abscess. She is started on
antibiotics and intravenous fluids with significant improvement in her
symptoms.

Questions

A. Describe the pathogenesis of diverticular disease.

B. Why should opioids be avoided in the treatment of her
abdominal pain?

C. What are the complications of diverticular disease?

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