Appendicitis and diverticulosis

Question 1

What are colonic diverticula?

Answer 1

herniations of colonic mucosa through the smooth muscle layers of the large intestine
occur in areas of anatomic weakness of circular smooth muscle

Question 2

Are colonic diverticula “true” diverticula?

Answer 2

No- pseudodiverticula, they do not include the full thickness of the bowel wall

Question 3

If small intestinal diverticula are numerous enough, they can harbor large numbers of gut microbes and lead to ______

Answer 3

SIBO: small intestinal bacterial overgrowth

Question 4

List factors associated with the high prevalence of colonic diverticula

Answer 4

low fiber diet

longevity

Question 5

Bleeding associated with diverticulosis is typically ______ and can be accompanied by _______

Answer 5

brisk; presyncope and orthostasis

pts may present wiht hematochezia

Question 6

Bleeding in diverticulosis is thought to occur when a _____ erodes into a small feeding arterial vessel in the neck of the diverticulum

Answer 6

fecalith

Question 7

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

Answer 7

hemorrhoids

Question 8

What is treatment for bleeding due to diverticulosis?

Answer 8

replacement of lost volume with IV crystalloids and serial red blood cell counts

Question 9

Describe the development of diverticulitis

Answer 9

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

Question 10

How does diverticulosis present?

Answer 10

suprpubic LLQ pain, low grade fever, LLQ tenderness, increased stooling
also: nausea, vomiting, bloating, decreased appetite

Question 11

What are complications of diverticulitis?

Answer 11

peri-diverticular abscess
fibrosis, stenosis and bowel obstruction
fistula to bladder, vagina, small intestine
perforation and peritonitis

Question 12

What key symptom can distinguish diverticulosis from diverticulitis?

Answer 12

PAIN

Diverticulosis itself does not cause symptoms, and in diverticulitis there is pain and fever.

Question 13

What are classic findings on CT for diverticulitis?

Answer 13

colon wall thickening and peri-colic fat stranding

Question 14

________ should NOT be used to diagnose diverticulitis due to risk of mechanical perforation

Answer 14

sigmoidoscopy, colonoscopy

Question 15

In mild to moderate diverticulitis, patients are treated with ______ (antibiotics) and a _____ diet

Answer 15

metronidazole + quinolone

low fiber diet during active disease

Question 16

What is treatment for severe diverticulitis?

Answer 16

surgery if abscess, fistula, perforation

partial colectomy if repeat infection or scarring with stenosis

Question 17

Chronic diverticulitis is treated with _______

Answer 17

mesalamine

Question 18

_______ is a leading cause of acute abdomen

Answer 18

appendicitis

Question 19

What is the cause of appendicitis?

Answer 19

obstruction of the appendiceal orifice with a fecalith

Question 20

What is a fecalith?

Answer 20

solid mass composed of thickened mucus, food particles, parasitic worms, etc

Question 21

In appendicitis, inflammation and infection can cause a ______ in the appendiceal vessels that could rapidly lead to gangrenous changes and perforation

Answer 21

thrombus

Question 22

Describe classic presentation of appendicitis

Answer 22

vague, periumbilical pain, which eventually migrates to the RLQ
+/- loss of appetite, nausea, vomiting, malaise, fatigue, gas, indigestion

Question 23

Physical exam findings in acute appendicitis include tenderness at _______

Answer 23

McBurney’s point

2/3 of the way between umbilicus and ASIS

Question 24

Variations in location of the _______ lead to different physical exam findings in different patients

Answer 24

anatomic location of appendix

Question 25

_______ and _______ signs may be present in acute appendicitis

Answer 25

psoas and obturator

Question 26

What lab findings may indicate acute appendicitis?

Answer 26

elevated WBCs, ESR, CRP

dysuria, sterile pyuria

Question 27

If a patient presents with _______, ______, ____, and ______ then appendicitis is always on the differential

Answer 27

anorexia, periumbilical pain, fever, leukocytosis

Question 28

What are the most serious complications of appendicitis?

Answer 28

perforation, peritonitis, abscess formation

Question 29

What is Zenker’s diverticulum?

Answer 29

A pseudodiverticulum at the crico-pharyngeus

Question 30

What are signs of Zenker’s diverticulum?

Answer 30

Halitosis
Regurgitation
Aspiration
Dysphagia

Question 31

What is treatment for Zenker’s diverticulum?

Answer 31

open surgery or endoscopy