Diverticulitis/cholecystitis/Pancreatitis

Question 1

Labs and Diagnostics of Diverticulitis

Answer 1

• moderate leukocytosis
• elevated ESR
• stool heme + in 25% of cases
• sigmoidoscopy shows inflamed mucosa
• may consider CT scan to evaluate abscess
• plain and films are obtained on all pts to look for evidence of free air (need to worry about perforation)

Question 2

Inpatient management of Diverticulitis

Answer 2

• NPO
• IV fluids
• IV abx: flagyl, cipro, deftazidime, cilnda, campicillin
• if significant Gi bleeding tx as outlined in PUD
• surgical consultation

Question 3

Physical findings of Cholecystitis

Answer 3

• • Murphy’s (deep pain on inspiration while fingers are placed under the right rib cage
• RUQ tenderness
• muscle guarding and rebound pain
• Fever

Question 4

Labs and Diagnostics of Choly

Answer 4

WBCs 12-15,000

• bilirubin may be elevated
• plain films may show gallstones
• HIDA scan
• U/S (gold standard)

Question 5

Management of choly

Answer 5

• pain mngt
• NGT for gastric decompression
• NPO
• crystalloid solutions
• IV abc, broad spectrum such as Piperacilin
• surgical consult

Question 6

What can gallbladder dz lead to?

Answer 6

Pancreatitis

Question 7

Which medications can lead to pancreatitis

Answer 7

Sulfonamides, Thiazides, lasix, estrogen or azathioprine

Question 8

Other causes of pancreatitis

Answer 8

Hypercalcemia
hyperlipidemia
trauma
alcohol

Question 9

what does abrupt onset of steady, severe epigastric pain worsened by walking and lying supine indicate

Answer 9

pancreatits

Question 10

What improves pain in pancreatits

Answer 10

Leaning and sitting forward

Question 11

Physical exam findings in pancreatitis

Answer 11

-upper abdomen tender, usually w/o guarding, rigidity or rebound
-distended abd
-pallor, cool skin
-fever, tachy
-mild jaundice is common
-

Question 12

what does Grey Turner’s sign and Cullen’s Sign indicate in pancreatits

Answer 12

Hemorrhagic.
Grey: flank discoloration
Cullen’s: umbilical discoloration

Question 13

Labs and diagnostics of pancreatitis

Answer 13

-hyperglycemia
-serumm LDh and AST elevation
amylase and lipase elevated
Hypocalcemia: < 7 a/w tetany; watch for chvostek’s and/or trousseau’s (carpopedal spasm) sign
CT scan more useful than U/S

Question 14

What elevated lab value would indicate pancreatic necrosis?

Answer 14

elevated C-reactive protein

Question 15

What criteria is used to evaluate prognosis of pancreatitis?

Answer 15

Ranson’s criteria

5-6 risk factors = 40% mortality; >7 risk factors = apps 100% mortality

Question 16

Prognostic signs of pancreatitis at admission

Answer 16

George: greater than 55 years
Washington: wbc > 16k
Got: glucose> 90
lazy: LDH > 350
After: AST > 250

Question 17

Prognostic signs during 1st 48 hours

Answer 17

He: hct drop > 10
Broke: Bun increases > 5
C-A-B-E:  
calcium < 8
arterial 02 < 60
Base deficity > 4
estimated fluid equestrian > 6,000 ml

Question 18

When can you start a clear diet for pt with acute pancreatitis

Answer 18

Once bowel sounds and is pain free