Diverticulosis, Diverticulitis, Appendicitis, Rectal Prolapse Flashcards
Major risk factor for diverticulosis
Low fiber diet
Most common symptom of diverticulitis
“Crampy” LLQ pain
Labs in appendicitis
Likely leukocytosis and neutrophilia
CRP not valuable until 12-24 hours after symptoms
Initial imaging method to use in a patient with diverticular bleeding
Colonoscopy
Location of appendicitis
Base of cecum, near ileocecal valve
Appendicitis treatments for non-perforated and perforated
ALL get IV antibiotics regardless of perforation
Perforation mandates surgery (non-perforated often removed also)
Immunocompromised required urgent appendectomy
Two main symptoms of diverticulosis
Left sided abdominal pain
Massive rectal bleeding
Antibiotics used in severe (complicated) diverticulitis
Monotherapy: Unasyn or Zosyn
Combination: (Levofloxacin or ciprofloxacin or cefazolin or ceftriaxone) PLUS metronidazole
Physical exam technique for rectal prolapse
Have patient strain to reproduce prolapse
Location of pain in appendicitis
Abdominal pain
Initially epigastric or periumbilical
Then becomes more localized to RLQ
Gold standard diagnosis for diverticulitis diagnosis
CT is gold standard
Is ultrasound used to confirm or exclude appendicitis?
Can only confirm, not exclude
Treatment of abscesses as a complication from diverticular disease
Antibiotics (unspecified)
Plus if >5cm, CT guided percutaneous drainage
Cause of appendicitis
Inflammation and obstruction of the appendix due to bacterial proliferation and luminal obstruction
If a patient with confirmed diverticulitis has peritoneal signs such as guarding, rigidity, or rebound tenderness this suggests …
Perforation
Main two symptoms of appendicitis
Abdominal pain (#1)
Anorexia
Antibiotics used in appendicitis
IV antibiotics 1-3 days followed by oral 7-10 days (think this is if surgery)
IV = (Ceftriaxone or cefazolin) PLUS metronidazole
Oral = (Augmentin or a fluoroquinolone) PLUS metronidazole
Gold standard diagnosis tool for appendicitis
Abdominal CT with contrast is gold standard
Most common locations for diverticulosis
Left colon
Sigmoid colon
Is diverticulosis more common in men or women and young or old?
Women and old
(2-3x more women than men and age over 60)
Most common symptoms of colon-bladder fistulas resulting from diverticular disease
Pneumaturia
Fecaluria
Dysuria
Treatment for rectal prolapse
Surgery is only cure
Is rectal prolapse more common in men or women and young or old?
Women and elderly
Cause of diverticulitis
Inflammation of diverticulosis, usually due to micro-perforation
May be secondary to abrasion by hard stool
Physical exam signs in appendicitis
McBurny’s point
Rovsings = peritoneal irritation
Obturator = inflamed appendix deep in hemipelvis
Psoas = inflamed appendix near psoas muscle (retrocecal)
Up to 50% of people with rectal prolapse have this complication which leads to atrophy of the external sphincter muscle
Pudendal neuropathy
Indications for hospitalization of a diverticulitis patient
Fever >101
Significant tenderness
Abdominal mass
Failure of 2-3 days outpatient therapy
Diverticulitis treatment
Liquid diet initially to rest bowels
Then increase fiber when symptoms resolve
Oral antibiotics for 7-14 days
Is appendicitis more common in men or women and young or old?
Young men (ages 10-30)
Signs and symptoms of perforation of a diverticular abscess
Generalized peritonitis, abdomen distended and very tender, rigidity
Bowel sounds absent
Perforation seen on CT (free air supine - crescent sign)
