Appendicitis, Diverticulitis & Intussusception

Question 1

what are 4 common etiologies of appendicitis?

Answer 1

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

Question 2

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

Answer 2

within 36 hrs of onset

Question 3

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?

Answer 3

appendicitis

Question 4

what physical finding indicates perforation of appendix?

Answer 4

rigid abdomen

Question 5

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

Answer 5

appendicitis

Question 6

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

Answer 6

could have an ectopic pregnancy

Question 7

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

Answer 7

CT w/ contrast

Question 8

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

Answer 8

U/S

Question 9

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

Answer 9

MRI

Question 10

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

Answer 10

antibiotics x 3-6 weeks

Question 11

what is the 2nd treatment option for appendicitis?

Answer 11

laparoscopic appendectomy

Question 12

what does a localized perforation of an appendix result in?

Answer 12

contained abscess

Question 13

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

Answer 13

suppurative peritonitis and sepsis

Question 14

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

Answer 14

drain abscess
antibiotics
appendectomy 6 weeks later

Question 15

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

Answer 15

appendectomy + antibiotics
abdominal lavage

Question 16

what area of the intestine does diverticulitis most commonly affect?

Answer 16

sigmoid colon

Question 17

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

Answer 17

diverticulosis

Question 18

what is the most common cause of a LGIB?

Answer 18

diverticulosis + diverticulitis

Question 19

what are 2 risk factors for diverticulosis?

Answer 19

inadequate dietary fiber
lack of physical activity

Question 20

inflammation of one or more diverticula

Answer 20

uncomplicated acute diverticulitis

Question 21

all diverticulitis is assumed to involve ___-_______

Answer 21

micro-perforations

Question 22

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

Answer 22

complicated diverticulitis

Question 23

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

Answer 23

diverticulitis

Question 24

what does complicated diverticulitis often present with in physical exam?

Answer 24

peritoneal signs

rebound tenderness
heel tap

Question 25

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

Answer 25

diverticulitis

Question 26

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

Answer 26

CT w/ contrast

Question 27

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

Answer 27

colonoscopy

Question 28

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

Answer 28

monitor clear liquid diet

Question 29

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

Answer 29

ciprofloxacin + metronidazole OR amoxicillin/clavulanate x 7-10 days clear liquid diet x 3 days high fiber diet after symptoms resolve

Question 30

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)

Answer 30

repeat CT surgical consult drainage if abscess > 2cm

Question 31

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

Answer 31

possible elective bowel resection

Question 32

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.

Answer 32

intussusception

Question 33

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

Answer 33

cecum ileum

Question 34

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

Answer 34

intussusception

Question 35

what should we suspect if an adult has an intussusception?

Answer 35

malignancy

Question 36

where is intussusception most commonly found in adults?

Answer 36

small intestine

Question 37

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?

Answer 37

intussusception

Question 38

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

Answer 38

sausage-shaped mass

Question 39

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

Answer 39

U/S target sign

Question 40

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

Answer 40

abdominal x-ray meniscus sign

Question 41

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

Answer 41

CT scan target sign

Question 42

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

Answer 42

radiopaque contrast enema w/ xray

Question 43

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

Answer 43

air enema

Question 44

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

Answer 44

surgical resection

Question 45

what are 5 complications of intussusception?

Answer 45

ischemic bowel necrosis perforation peritonitis septic shock