Appendicitis, Diverticulitis & Intussusception Flashcards
what are 4 common etiologies of appendicitis?
fecalith (most common cause)
intestinal inflammation
foreign body
cancer/tumor
how long can it take for an appendix to develop gangrene and perforate?
within 36 hrs of onset
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?
appendicitis
what physical finding indicates perforation of appendix?
rigid abdomen
a patient’s lab show a left shift (neutrophils) in elevated WBCs and microscopic hematuria and pyuria. Dx?
appendicitis
why is it important to get a pregnancy test in a female patient complaining of appendicitis pain?
could have an ectopic pregnancy
what is the most accurate and the adult diagnostic of choice for appendicitis?
CT w/ contrast
what is the diagnostic of choice for pediatrics and pregnant females with appendicitis?
U/S
what is the 2nd diagnostic that can be used for pediatrics and pregnant females with appendicitis?
MRI
what is the treatment for an acute uncomplicated case of appendicitis in a healthy patient?
antibiotics x 3-6 weeks
what is the 2nd treatment option for appendicitis?
laparoscopic appendectomy
what does a localized perforation of an appendix result in?
contained abscess
what does a free perforation of an appendix result in? (2)
suppurative peritonitis and sepsis
what is the treatment for a perforated appendix with a contained abscess? (3)
drain abscess
antibiotics
appendectomy 6 weeks later
what is the treatment for a free perforation of an appendix? (3)
appendectomy + antibiotics
abdominal lavage
what area of the intestine does diverticulitis most commonly affect?
sigmoid colon
outpouching of the colon wall that develops at well-defined points of weakness where blood vessels penetrate the circular muscle layer of the colon
diverticulosis
what is the most common cause of a LGIB?
diverticulosis + diverticulitis
what are 2 risk factors for diverticulosis?
inadequate dietary fiber
lack of physical activity
inflammation of one or more diverticula
uncomplicated acute diverticulitis
all diverticulitis is assumed to involve ___-_______
micro-perforations
acute diverticulitis with abscess, fistula, perforation bigger than micro-perf, or bowel obstruction
complicated diverticulitis
a patient presents with abdominal pain (LLQ or suprapubic region), N/V/D, constipation, fever, +/- palpable mass. Dx?
diverticulitis
what does complicated diverticulitis often present with in physical exam?
peritoneal signs
rebound tenderness
heel tap
a patient labs show leukocytosis with a + left shift (neutrophils) and +FOBT. Dx?
diverticulitis
what is the preferred imaging for mod-severe symptoms of diverticulitis?
CT w/ contrast
what diagnostic should be avoided in a patient with possible diverticulitis?
colonoscopy
what is the medical management for mild symptoms of diverticulitis? (2)
monitor
clear liquid diet
what is the medical management for mod-severe symptoms of diverticulitis? (3)
ciprofloxacin + metronidazole OR amoxicillin/clavulanate x 7-10 days
clear liquid diet x 3 days
high fiber diet after symptoms resolve
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)
repeat CT
surgical consult
drainage if abscess > 2cm
what should we do if a patient has repeated attacks of diverticulitis?
possible elective bowel resection
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.
intussusception
majority of intussusception occurrences are pediatrics with _____ intussuscepting into the _____
cecum
ileum
what is the most common abdominal surgical emergency in early childhood?
intussusception
what should we suspect if an adult has an intussusception?
malignancy
where is intussusception most commonly found in adults?
small intestine
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?
intussusception
what may be palpated on a child’s abdomen if they have intussusception?
sausage-shaped mass
what is the imaging of choice for intussusception in pediatrics? what will be seen?
U/S
target sign
what imaging can be used to find bowel obstruction in intussusception? what will it show?
abdominal x-ray
meniscus sign
what is a 3rd imaging of choice for intussusception? what will it show?
CT scan
target sign
what is the diagnostic and possible treatment of choice for intussusception in children?
radiopaque contrast enema w/ xray
what is the treatment for non-perforated children with intussusception after contrast enema attempt?
air enema
what is the treatment for intussusception in adults and perforated children?
surgical resection
what are 5 complications of intussusception?
ischemic bowel
necrosis
perforation
peritonitis
septic shock
