Appendicitis/ Diverticulitis

Question 1

Give examples of true and pseudodiverticulum.

Answer 1

true (includes the muscle): Meckel’s, normal appendix

pseudo (through the muscle): Zenker’s esophageal, Common colon ticks

Question 2

What are the symptoms of a Zenker’s diverticulum? Where does it form?

Answer 2

halitosis, regurgitation, aspiration, dysphagia (more common in elderly patients)

forms as an out-pocketing above the cricopharynxgeus muscle

Question 3

How is Zenker’s diverticulum treated?

Answer 3

diverticulotomy with CP myotomy via open surgery or endoscopy

Question 4

How does the geographic distribution of diverticulosis vary?

Answer 4

common in the West, unusual in Africa, Asia; more common in higher socioeconomic groups and in older adults (attributed to low fiber diets)

Question 5

Where in the colon (anatomically) due diverticulae form?

Answer 5

form between the tine coli at places where vessels pierce the muscle wall, possibly due to high pressure or low fiber

Question 6

Where are the most common places for diverticulum?

Answer 6

sigmoid and descending colon

Question 7

What is the most common presentation of diverticulitis?

Answer 7

LLQ pain and ‘fever’ is the most common presentation although 80% have no symptoms, massive painless bleeding is possible (erosion into vasa recta, small arteriole on edge of diverticulum)

Question 8

What types of diagnostic tests and treatment would you use with suspected diverticulosis in the clinic v. hospital?

Answer 8

clinic: clinical presentation of LLQ tenderness, pain, and low grade fever, -/+ known hx of tics
hospital: elevated WBC, fever, CT showing thickening of the abdominal with fat stranding

tx w/transfusion if blood loss extensive, and with melamine as in colitis

Question 9

What are possible complications of diverticulitis?

Answer 9

abscess (drain percutaneously, IV abx)
fistualae (surgical repair)
stricture (segemental colon resection)

Question 10

Describe the most common age group to be affected by appendicitis and how elderly may present.

Answer 10

peak incidence in teens and twenties or in pregnancy

elderly may present with ‘failure to thrive,’ general malaise or normal exam

Question 11

Describe the pathogenesis of appendicitis.

Answer 11

obstruction at the orifice with secondary distention, bacterial invasion and expansion

Question 12

How can the ureter or rectum be effected by appendicitis?

Answer 12

close relation to rectum can lead to tenderness on R side on digital rectal exam
closer relation to ureter may cause sterile pyuria

Question 13

What are the classic symptoms of appendicitis?

Answer 13

mid abdominal pain that migrate to the right lower quadrant pain accompanied by fatigue, malaise, flu-like, nausea and vomiting; increased WBC

CT of the abdomen may reveal edema, fat stranding, free perforation or micro perforation and abscess

tx with IV abs and appendectomy

Question 14

Obturator and psoas signs are possitive with what position of appendix?

Answer 14

obturator: pelvic appendix
psoas: retroceal appendix

Question 15

Name possible complications of appendicitis.

Answer 15

perforation (risk increases quickly after 24hrs), most common in young and elderly
peritonitis
abscess
pyelophlebitis (rare)

Question 16

What makes a diverticulum likely to fistualize?

Answer 16

diverticulae are not formed from true wall and therefore more easily form diverticula

Question 17

Appendicitis can also present like what other GI illness?

Answer 17

acute Crohn’s