From the Guidelines
The patient's abdominal pain should be managed by addressing the symptomatic conditions, including lifestyle modifications for hepatic steatosis and hiatal hernia, further gynecological evaluation for suspected uterine fibroids, and consideration of the patient's overall clinical presentation to determine the best course of action for her diverticulosis coli and vascular atherosclerosis. The CT scan findings provide a comprehensive view of the patient's abdominal conditions, including hepatic steatosis, a small hiatal hernia, diverticulosis coli without evidence of diverticulitis, suspected leiomyomatous involvement of the uterus, and vascular atherosclerosis 1. Given the absence of diverticulitis, the focus should be on managing the patient's symptoms and addressing the potential causes of her abdominal pain. The patient's hepatic steatosis and hiatal hernia can be managed with lifestyle modifications, such as weight loss if appropriate, and anti-reflux measures, including avoiding trigger foods, not eating before bedtime, and elevating the head of the bed. Further gynecological evaluation is necessary to determine the significance of the suspected uterine fibroids and their potential contribution to the patient's symptoms. The presence of vascular atherosclerosis is a common finding at this age and should be managed according to current guidelines. It is essential to consider the patient's overall clinical presentation and medical history when determining the best course of action for her diverticulosis coli and other conditions. The American College of Physicians suggests that clinicians use abdominal CT imaging when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis, as it has high sensitivity and specificity for diagnosing diverticulitis 1. However, in this case, the CT scan did not show evidence of diverticulitis, and the management should focus on addressing the symptomatic conditions and preventing potential complications. Pain management should be tailored to the specific cause of the patient's symptoms, and further evaluation and treatment should be guided by the patient's clinical presentation and response to initial management. The patient's quality of life and potential morbidity and mortality associated with her conditions should be considered when making treatment decisions, and the management plan should be individualized to address her unique needs and circumstances.
From the Research
CT Findings in a 59-Year-Old Female with Unresolved Abdominal Pain
The patient's CT scan revealed several findings, including:
- Hepatic steatosis, which is defined as intrahepatic fat of at least 5% of liver weight 2
- Small hiatal hernia
- Diverticulosis coli, with no CT evidence of diverticulitis
- Suspected possible leiomyomatous involvement of the uterus
- Vascular atherosclerosis
Hepatic Steatosis
Hepatic steatosis can occur due to nonalcoholic fatty liver disease (NAFLD), alcoholism, chemotherapy, and metabolic, toxic, and infectious causes 3. The condition is associated with obesity, type 2 diabetes, and dyslipidemia 2. The mechanisms involved in the accumulation of intrahepatic fat include increased flux of fatty acids to the liver, increased de novo lipogenesis, and/or reduced clearance through β-oxidation or very-low-density lipoprotein secretion 2.
Diagnostic Value of CT
CT is an excellent examination technique for patients with acute abdomen, regardless of the duration of signs and symptoms 4. It is particularly useful in defining the cause and therapeutic strategy in patients with acute abdomen who have no history of abdominal disease 4. CT plays a key role in emergent triage, proper treatment, and decision-making in patients with suspected small bowel obstruction 5.
Associations with Acute and Chronic Liver Diseases
Hepatic steatosis is a common finding in liver histopathology and is associated with metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD) 6. The condition can progress to steatohepatitis (nonalcoholic steatohepatitis), which can result in cirrhosis 3. Hepatic steatosis is also associated with diverse liver pathologies, with MASLD being the most important contributor 6.