Appendicitis + Diverticulitis

Question 1

Investigations for ?appendicitis

Answer 1

For exclusions: PT, urine dip, USS

Question 2

Presentation of appendicitis + signs present

Answer 2

Pain in umbilical region radiating to RIF, worse on movement
Anorexia
N+V
Constipation
Rovsing’s sign: pressing LIF causes pain in RIF
Psoas sign: RIF pain with extension of right hip

Question 3

Difference between appendicitis + mesenteric adenitis

Answer 3

Mesenteric: high temp, previous viral infection

Question 4

Management of appendicitis

Answer 4

Appendicectomy
Metronidazole +- cefuroxime IV starting pre-op to reduce wound infection
Metoclopramide as anti-emetic

Question 5

S+S diverticulitis

Answer 5

Lower abdo dull constant pain - typically LIF
Low grade fever
Tenderness, rigidity
Bloody diarrhoea
Large, painless rectal bleed
Symptoms improve with defecation + worsen with eating

Question 6

Investigations + results for ?diverticulitis

Answer 6

Bloods inc lactate
CXR - shows pneumoperitoneum
AXR - shows ileus, dilatation, obstruction
Abdo CT with contrast - thickening of colonic wall, pericolonic fat, abscesses, localised air bubbles or free air

Question 7

Complications of appendicitis

Answer 7

Perforation
Surgical site infection
Appendix mass
Pelvic abscess

Question 8

Difference between diverticulosis, diverticular disease + diverticulitis

Answer 8

Diverticulosis - presence of diverticulum, no symptoms
Diverticular disease - symptomatic
Diverticulitis - inflammation of diverticulum

Question 9

Complications of diverticular disease

Answer 9

Pericolic abscess - treat with abx + bowel rest then CT guided drainage
Fistular formation
Bowel obstruction (post infective stricture)
Haemorrhage - sudden + painless
Ischemic colitis

Question 10

What is the Hinchey classification?

Answer 10

CT description of diverticulitis

1: diverticulitis with mesenteric abscess
2: diverticulitis with pelvic abscess
3: diverticulitis with purulent peritonitis
4: diverticulitis with faecal peritonitis

Question 11

Management of diverticulitis

Answer 11

Conservative: abx (co-amox + metronidazole), fluids, bowel rest, analgesia - should improve within 2-3 days
Anti-spasmodics - mebevarine
Surgery (bowel resection - Hartman’s procedure) - if perforation, sepsis or failing to improve
Follow up with colonoscopy

Question 12

RF for diverticular

Answer 12

Low fibre diet
Increasing age
Smoking
NSAIDs

Question 13

Mechanism of diverticular

Answer 13

Muscle hypertrophy + increased intraluminal pressure
Mucosa patches are pushed out through colonic wall
95% in sigmoid colon

Question 14

Signs of perforated diverticular

Answer 14

Ileus, peritonitis, shock

Question 15

What is complicated vs uncomplicated diverticulitis?

Answer 15

Uncomplicated = localised inflammation 
Complicated = associated with complications

Question 16

Pathology of appendicitis

Answer 16

Inflammation of appendix, secondary to infection caused by blockage, usually faecolith or lymphoid hyperplasia (due to viral infection)

Question 17

RF for appendicitis

Answer 17

10-20 y/o
Male
Frequent abx use
Smoking

Question 18

Complications of appendicitis

Answer 18

Appendix perforation, generalized peritonitis, appendix mass or abscess, adhesions, sepsis

Question 19

In what groups does appendicitis appear atypically?

Answer 19

Young children, pregnant women + the elderly