Appendicitis/Diverticular Dz/Ischemic BD Flashcards
Whats the most common age range for someone to get appendicitis
10-30 years.
what do you suspect in a pt who started w/ periumbilical pain that radiated to RLQ
appendicitis
in which order would you suspect symptoms of a pt w/ appendicitis
radiation of pain from periumbilical region to RLQ 1st, N&V next and later fever
Which PE test would you perform to confirm appendicitis
check for pain at McBurney’s Point (1/3 distance btw ASIS & belly button)
what are other diagnostic tests used for appendicitis performed during PE
Rovsing sign, psoas sign, obturator sign, heel/ jar drop
what do you expect to find on labs for appendcitis
leukocytosis w/ bandemia WBC’s>14,000
>20,000 suggests perforation, an increased CRP
What is the Alvarado score used for…
assessing appendicitis: 99% had >5 so better use to R/O. < 3 send home. 3-5 get CT, > 7 surg. consult
what is the imaging of choice for appendicitis? Gold Standard of Tx>
Ct scan, appendectomy
Where is the most commonly affected area for ppl with diverticulum?
sigmoid colon (LLQ) Except Asians on rt. side
why are imaging not usually recommended in pt with diverticulum?
typically asx
how would you counsel a pt who has diverticulum.
increase fiber, water, exercise, lose wt.
what do you suspect with painless hematochezia
diverticular bleeding
how do you treat diverticular bleeding?
colonoscopy w/ electrocautery is 1st line for those who don’t stop spontaneously (75%)
in a pt with LLQ pain and leukocytosis what is ur suspicion?
diverticulitis
what is the image of choice for diverticulitis
CT showing thickened bowell wall
what is the tx of choice for diverticultis
hospitalized w/ abx (zosyn/unasyn for IP, Cipro/Flagyl for OP) Don’t do colonoscopy until month out
ischemic bowel disease has what hallmark finding….
pain out of proportion to exam
in a pt that shows a narrowed intestine at the splenic flexure is most likely experiencing this
ischemic bowel disease
what are the 3 phases of ischemic bowel dz
Hyperactive-severe pain w/ frequent passage of loose, bloody stools
Paralytic-pain diminished, becomes more diffuse/tender abd
Shock-massive fluid, electrolytes leak thru gangrenous mucosa, severe dehydration/met. acidosis
Risk Factors for ischemic bowel dz
age, atherosclerosis, low CO state, arrhythmias, valve dz, PVD, MI, hypercoagulability, abd malignancy
what finding is a key on CT to indicate ischemic bowel dz
pneumotosis intestinalis (bubble like) stranding, wall thickening.
what is the gold standard and tx of choice for ischemic bowel dz
exploratory laparotomy, w/ open lap. as 1st line….
why is time to tx crucial in pt with ischemic bowel dz
50-75% mortality!
