Appendicitis, Diverticulitis, Pancreatitis Flashcards
Appendicitis Clinical Manifestations
pain initially periumbilical, then RLQ
Psoas/Obturator/McBurney’s/Rovsings sign
abd rigidity, guarding
nausea
anorexia
fever
dysuria
nonspecific in elderly
perf rate > 50% in those > 50
Appendicitis Diagnosis
exam?
Labs?
Imaging?
abd pain, localized tenderness
CBC, UA
CT scan with IV contrast
Appendicitis management
IVF
Abx
Surgical intervention
Appendicitis Surgical interventions
Surgical intervention for who?
What is acceptable if marked improvement in condition?
Types of acceptable procedures?
urgent surgical procedure if?
If abscess do what?
acute, nonperforated appendicitis may be performed ASAP or deferred for short period of time
non-op
laparoscopic & open procedures
perforation
percutaneous or surgical drng
Diverticulitis Risk Factors include?
low fiber diet (risk); best to consume diet high in fiber, low in red meat & sweets
Obesity
physical inactivity
increasing age
Diverticulitis Clinical Manifestations
fever
anorexia
N/V
altered bowel pattern; constipation
Urinary symptoms
LLQ pain with possible radiation to flank, back or suprapubic area
/
Diverticulitis Diagnosis
labs?
Imaging?
CBC
abd plain film to r/o free air
CT scan colonic wall thickening, inflammation of pericolic fat
Diverticulitis Management
clear liquid diet; ADAT
IVF
Abx
surgery if peritonitis
Percutaneous drng if abscess
Abx not recommended for diverticulitis if patients are
immunocompetent
acute
mild
uncomplicated
Pancreatitis Etiology
biliary tract dz (40%) - gallstone passes thru bile duct & lodges @ sphincter of oddi
ETOH (35%) - usually from chronic use
post ERCP (4%)
Trauma (1.5%) - usually from penetrating injuries
hypertriglyceridemia (<1%)
Pancreatitis Clinical Manifestations
Epigastric pain with radiation to back in 1/2 of cases
abrupt onset with max intensity w/n 30 min, last > 24hrs
N/V
upper abd tenderness, guarding on exam
Pancreatitis Diagnosis
Requires 2/3 features
- abd pain suggestive of pancreatitis
- amylase & lipase > 3x upper limit of NL
- CT scan c/w disease
Pancreatitis
Which lab may be more sensitive & specific, & remain higher for longer?
Lipase > amylase
Pancreatitis labs to get?
CBC
CMP
blood glucose
triglycerides
amylase
lipase
Pancreatitis Imaging
on admisision?
48-72 hrs if no improvement in S&S?
U/S
CT or MRI
Pancreatitis CT or MRI findings may include
enlargement of pancreas
diffuse edema
heterogeneity of parenchyma
peripancreatic stranding
peripancreatic fluid collections
necrosis may be present
May reveal possible etiology of pancreatitis - CBD stone, mass, calcifications
Assessing Pancreatitis Severity on admission
What should be assessed immediately on presentation?
do what to assist triage?
ID what instead of scoring system?
If signs of organ failure send patient where?
HD Status
risk assessment to stratify into higher & lower categories
patient related risks
ICU or OU
Mild Acute Pancreatitis
Absence of organ failure
Absence of local complications
Moderately Severe Acute Pancreatitis
Local complications AND/OR
Transient organ failure (<48hrs)
Severe Acute Pancreatitis
Persistent Organ failure > 48hrs
Local complications for acute pancreatitis include?
pancreatic necrosis
+/- transient organ failure
Pancreatitis Management
aggressive fluid resuscitation/optimization of CO
freq VS, O2 sats
freq labs - CBC, Renal fxn, Ca+
respiratory support (O2, MV)
Pain control
Nutrition
In Mild acute pancreatitis PO feedings can be started immediately if there is no what? and what has resolved?
In mild AP, initiation of feeding with a low-fat sold diet appears how in comparison to clear liquid diet?
In Sever AP what type of nutrition is recommended? why? What should be avoided?
NG delivery and NJ delivery of enteral feeding appear how in efficacy and safety?
N/V; abdominal pain has resolved
as safe as
enteral nutrition to prevent infectious complications; parenteral nutrition
compareable
Recommended Imaging Studies Based on Location of Abdominal Pain
RUQ
LUQ
RLQ
LLQ
Suprapubic
US
CT
CT w/ IV contrast
CT w/ PO and IV contrast
US
