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Gastroenterology > Appendicitis, Diverticulitis & Intussusception > Flashcards

Appendicitis, Diverticulitis & Intussusception Flashcards

1
Q

what are 4 common etiologies of appendicitis?

A

fecalith (most common cause)
intestinal inflammation
foreign body
cancer/tumor

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2
Q

how long can it take for an appendix to develop gangrene and perforate?

A

within 36 hrs of onset

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3
Q

a patient presents with fever, loss of appetite, N/V/D, epigastric discomfort that moves towards umbilicus, then to RLQ and patient is laying in the fetal position. Dx?

A

appendicitis

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4
Q

what physical finding indicates perforation of appendix?

A

rigid abdomen

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5
Q

a patient’s lab show a left shift (neutrophils) in elevated WBCs and microscopic hematuria and pyuria. Dx?

A

appendicitis

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6
Q

why is it important to get a pregnancy test in a female patient complaining of appendicitis pain?

A

could have an ectopic pregnancy

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7
Q

what is the most accurate and the adult diagnostic of choice for appendicitis?

A

CT w/ contrast

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8
Q

what is the diagnostic of choice for pediatrics and pregnant females with appendicitis?

A

U/S

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9
Q

what is the 2nd diagnostic that can be used for pediatrics and pregnant females with appendicitis?

A

MRI

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10
Q

what is the treatment for an acute uncomplicated case of appendicitis in a healthy patient?

A

antibiotics x 3-6 weeks

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11
Q

what is the 2nd treatment option for appendicitis?

A

laparoscopic appendectomy

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12
Q

what does a localized perforation of an appendix result in?

A

contained abscess

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13
Q

what does a free perforation of an appendix result in? (2)

A

suppurative peritonitis and sepsis

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14
Q

what is the treatment for a perforated appendix with a contained abscess? (3)

A

drain abscess
antibiotics
appendectomy 6 weeks later

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15
Q

what is the treatment for a free perforation of an appendix? (3)

A

appendectomy + antibiotics
abdominal lavage

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16
Q

what area of the intestine does diverticulitis most commonly affect?

A

sigmoid colon

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17
Q

outpouching of the colon wall that develops at well-defined points of weakness where blood vessels penetrate the circular muscle layer of the colon

A

diverticulosis

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18
Q

what is the most common cause of a LGIB?

A

diverticulosis + diverticulitis

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19
Q

what are 2 risk factors for diverticulosis?

A

inadequate dietary fiber
lack of physical activity

20
Q

inflammation of one or more diverticula

A

uncomplicated acute diverticulitis

21
Q

all diverticulitis is assumed to involve ___-_______

A

micro-perforations

22
Q

acute diverticulitis with abscess, fistula, perforation bigger than micro-perf, or bowel obstruction

A

complicated diverticulitis

23
Q

a patient presents with abdominal pain (LLQ or suprapubic region), N/V/D, constipation, fever, +/- palpable mass. Dx?

A

diverticulitis

24
Q

what does complicated diverticulitis often present with in physical exam?

A

peritoneal signs

rebound tenderness
heel tap

25
Q

a patient labs show leukocytosis with a + left shift (neutrophils) and +FOBT. Dx?

A

diverticulitis

26
Q

what is the preferred imaging for mod-severe symptoms of diverticulitis?

A

CT w/ contrast

27
Q

what diagnostic should be avoided in a patient with possible diverticulitis?

A

colonoscopy

28
Q

what is the medical management for mild symptoms of diverticulitis? (2)

A

monitor
clear liquid diet

29
Q

what is the medical management for mod-severe symptoms of diverticulitis? (3)

A

ciprofloxacin + metronidazole OR amoxicillin/clavulanate x 7-10 days

clear liquid diet x 3 days

high fiber diet after symptoms resolve

30
Q

what is the management for diverticulitis in a patient with severe disease or any patient that does not improve after 72 hours of antibiotics? (3)

A

repeat CT
surgical consult
drainage if abscess > 2cm

31
Q

what should we do if a patient has repeated attacks of diverticulitis?

A

possible elective bowel resection

32
Q

a segment of bowel slides into the lumen of the proximal segment in “telescoping” movement leading to a bowel obstruction, leading to mechanical obstruction of food and fluid, possible infection, necrosis, and perforation.

A

intussusception

33
Q

majority of intussusception occurrences are pediatrics with _____ intussuscepting into the _____

A

cecum
ileum

34
Q

what is the most common abdominal surgical emergency in early childhood?

A

intussusception

35
Q

what should we suspect if an adult has an intussusception?

A

malignancy

36
Q

where is intussusception most commonly found in adults?

A

small intestine

37
Q

a patient presents with sudden onset of severe, worsening abdominal pain, legs are drawn to abdomen, fever, vomiting, stools that look like currant jelly, and tender abdomen. Dx?

A

intussusception

38
Q

what may be palpated on a child’s abdomen if they have intussusception?

A

sausage-shaped mass

39
Q

what is the imaging of choice for intussusception in pediatrics? what will be seen?

A

U/S
target sign

40
Q

what imaging can be used to find bowel obstruction in intussusception? what will it show?

A

abdominal x-ray
meniscus sign

41
Q

what is a 3rd imaging of choice for intussusception? what will it show?

A

CT scan
target sign

42
Q

what is the diagnostic and possible treatment of choice for intussusception in children?

A

radiopaque contrast enema w/ xray

43
Q

what is the treatment for non-perforated children with intussusception after contrast enema attempt?

A

air enema

44
Q

what is the treatment for intussusception in adults and perforated children?

A

surgical resection

45
Q

what are 5 complications of intussusception?

A

ischemic bowel
necrosis
perforation
peritonitis
septic shock

Gastroenterology (26 decks)

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