Appendicitis and diverticulosis Flashcards
What are colonic diverticula?
herniations of colonic mucosa through the smooth muscle layers of the large intestine
occur in areas of anatomic weakness of circular smooth muscle
Are colonic diverticula “true” diverticula?
No- pseudodiverticula, they do not include the full thickness of the bowel wall
If small intestinal diverticula are numerous enough, they can harbor large numbers of gut microbes and lead to ______
SIBO: small intestinal bacterial overgrowth
List factors associated with the high prevalence of colonic diverticula
low fiber diet
longevity
Bleeding associated with diverticulosis is typically ______ and can be accompanied by _______
brisk; presyncope and orthostasis
pts may present wiht hematochezia
Bleeding in diverticulosis is thought to occur when a _____ erodes into a small feeding arterial vessel in the neck of the diverticulum
fecalith
Patients may confuse the bleeding from diverticulosis with bleeding due to _______ though it is uncommon for these other causes of BRBPR to cause significant blood loss
hemorrhoids
What is treatment for bleeding due to diverticulosis?
replacement of lost volume with IV crystalloids and serial red blood cell counts
Describe the development of diverticulitis
Inflammation begins at the apex of the diverticulum when the opening of a diverticulum becomes obstructed (e.g. with stool called a fecalith), leading to micro- or macroperforation of a diverticulum
How does diverticulosis present?
suprpubic LLQ pain, low grade fever, LLQ tenderness, increased stooling
also: nausea, vomiting, bloating, decreased appetite
What are complications of diverticulitis?
peri-diverticular abscess
fibrosis, stenosis and bowel obstruction
fistula to bladder, vagina, small intestine
perforation and peritonitis
What key symptom can distinguish diverticulosis from diverticulitis?
PAIN
Diverticulosis itself does not cause symptoms, and in diverticulitis there is pain and fever.
What are classic findings on CT for diverticulitis?
colon wall thickening and peri-colic fat stranding
________ should NOT be used to diagnose diverticulitis due to risk of mechanical perforation
sigmoidoscopy, colonoscopy
In mild to moderate diverticulitis, patients are treated with ______ (antibiotics) and a _____ diet
metronidazole + quinolone
low fiber diet during active disease
What is treatment for severe diverticulitis?
surgery if abscess, fistula, perforation
partial colectomy if repeat infection or scarring with stenosis
Chronic diverticulitis is treated with _______
mesalamine
_______ is a leading cause of acute abdomen
appendicitis
What is the cause of appendicitis?
obstruction of the appendiceal orifice with a fecalith
What is a fecalith?
solid mass composed of thickened mucus, food particles, parasitic worms, etc
In appendicitis, inflammation and infection can cause a ______ in the appendiceal vessels that could rapidly lead to gangrenous changes and perforation
thrombus
Describe classic presentation of appendicitis
vague, periumbilical pain, which eventually migrates to the RLQ
+/- loss of appetite, nausea, vomiting, malaise, fatigue, gas, indigestion
Physical exam findings in acute appendicitis include tenderness at _______
McBurney’s point
2/3 of the way between umbilicus and ASIS
Variations in location of the _______ lead to different physical exam findings in different patients
anatomic location of appendix
