Inflammatory bowel disease (IBD): Although it is mostly diagnosed before the age of thirty, some patients may not manifest the signs and symptoms even till 50 years of age. It is characterised by inflammatory changes in the walls of the intestine demonstrated by changes in the bowel habits and appetite. In the given case the patient experiences loss of appetite, fever, tachycardia and tachypnea which suggest the probability of this condition. However, most of the cases of IBD are presented with diarrhea, whereas this patient is constipated since the last two days (Mayo Clinic Staff, 2016)
Sigmoid Diverticulitis: This is another diagnosis which should be ruled out in a patient presented with the given sets of symptoms. Diverticulitis stands for the condition when diverticulosis undergoes infection or inflammation. The given patient has shown the signs of inflammation in the form of fever and its associated symptoms, tenderness, rigidity and abdominal distension further support the diagnosis (Marks, 2016).
Volvulus: This is another diagnosis which is although rare but do corroborate with the given case. The signs and symptoms like tenderness, abdomen distension, pain and constipation at an age beyond 40 indicate towards this condition. However, lack of inflammatory features in this condition refutes the diagnosis to some extent (Thornton, 2015).
The case history and the past history helps in pointing out that the patient had a tendency to develop abdominal inflammatory complaints since a very young age. Being a hypertensive patient, he also predisposes to develop aneurismal problems. Therefore, at the time of diagnosis it becomes extremely important to consider the probability of an aneurismal rupture.
The treatment should begin with laxatives so that the bowels can be cleared. It could be possible that the only problem with the patient is obstruction of feces in the bowel and clearing the same will resolve the case completely. Following the laxatives, the patient should be administered some NSAIDs in order to control the inflammatory symptoms.
Bisacodyl 10mg rectal liquid/ STAT
Ibuprofen 200mg orally/ 4 hourly
Further treatment will depend on the results of the diagnostic tests to be carried upon the patient, like CBC and Ultrasound
References
Marks, J. (2016). Diverticulitis (Diverticulosis, Diverticular Disease) Symptoms, Causes, Treatment - What is diverticulosis? - MedicineNet. MedicineNet. Retrieved 6 April 2016, from http://www.medicinenet.com/diverticulosis/page2.htm
Mayo Clinic Staff,. (2016). Inflammatory bowel disease (IBD) Symptoms - Mayo Clinic.Mayoclinic.org. Retrieved 6 April 2016, from http://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/basics/symptoms/con-20034908
Thornton, S. (2015). Sigmoid and Cecal Volvulus Clinical Presentation: History, Physical Examination.Emedicine.medscape.com. Retrieved 6 April 2016, from http://emedicine.medscape.com/article/2048554-clinical#b3
