Diverticulosis, Diverticulitis, Appendicitis, Rectal Prolapse

Question 1

Major risk factor for diverticulosis

Answer 1

Low fiber diet

Question 2

Most common symptom of diverticulitis

Answer 2

“Crampy” LLQ pain

Question 3

Labs in appendicitis

Answer 3

Likely leukocytosis and neutrophilia

CRP not valuable until 12-24 hours after symptoms

Question 4

Initial imaging method to use in a patient with diverticular bleeding

Answer 4

Colonoscopy

Question 5

Location of appendicitis

Answer 5

Base of cecum, near ileocecal valve

Question 6

Appendicitis treatments for non-perforated and perforated

Answer 6

ALL get IV antibiotics regardless of perforation

Perforation mandates surgery (non-perforated often removed also)

Immunocompromised required urgent appendectomy

Question 7

Two main symptoms of diverticulosis

Answer 7

Left sided abdominal pain

Massive rectal bleeding

Question 8

Antibiotics used in severe (complicated) diverticulitis

Answer 8

Monotherapy: Unasyn or Zosyn

Combination: (Levofloxacin or ciprofloxacin or cefazolin or ceftriaxone) PLUS metronidazole

Question 9

Physical exam technique for rectal prolapse

Answer 9

Have patient strain to reproduce prolapse

Question 10

Location of pain in appendicitis

Answer 10

Abdominal pain

Initially epigastric or periumbilical

Then becomes more localized to RLQ

Question 11

Gold standard diagnosis for diverticulitis diagnosis

Answer 11

CT is gold standard

Question 12

Is ultrasound used to confirm or exclude appendicitis?

Answer 12

Can only confirm, not exclude

Question 13

Treatment of abscesses as a complication from diverticular disease

Answer 13

Antibiotics (unspecified)

Plus if >5cm, CT guided percutaneous drainage

Question 14

Cause of appendicitis

Answer 14

Inflammation and obstruction of the appendix due to bacterial proliferation and luminal obstruction

Question 15

If a patient with confirmed diverticulitis has peritoneal signs such as guarding, rigidity, or rebound tenderness this suggests …

Answer 15

Perforation

Question 16

Main two symptoms of appendicitis

Answer 16

Abdominal pain (#1)

Anorexia

Question 17

Antibiotics used in appendicitis

Answer 17

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

Question 18

Gold standard diagnosis tool for appendicitis

Answer 18

Abdominal CT with contrast is gold standard

Question 19

Most common locations for diverticulosis

Answer 19

Left colon

Sigmoid colon

Question 20

Is diverticulosis more common in men or women and young or old?

Answer 20

Women and old

(2-3x more women than men and age over 60)

Question 21

Most common symptoms of colon-bladder fistulas resulting from diverticular disease

Answer 21

Pneumaturia

Fecaluria

Dysuria

Question 22

Treatment for rectal prolapse

Answer 22

Surgery is only cure

Question 23

Is rectal prolapse more common in men or women and young or old?

Answer 23

Women and elderly

Question 24

Cause of diverticulitis

Answer 24

Inflammation of diverticulosis, usually due to micro-perforation

May be secondary to abrasion by hard stool

Question 25

Physical exam signs in appendicitis

Answer 25

McBurny’s point
Rovsings = peritoneal irritation
Obturator = inflamed appendix deep in hemipelvis
Psoas = inflamed appendix near psoas muscle (retrocecal)

Question 26

Up to 50% of people with rectal prolapse have this complication which leads to atrophy of the external sphincter muscle

Answer 26

Pudendal neuropathy

Question 27

Indications for hospitalization of a diverticulitis patient

Answer 27

Fever >101
Significant tenderness
Abdominal mass
Failure of 2-3 days outpatient therapy

Question 28

Diverticulitis treatment

Answer 28

Liquid diet initially to rest bowels

Then increase fiber when symptoms resolve

Oral antibiotics for 7-14 days

Question 29

Is appendicitis more common in men or women and young or old?

Answer 29

Young men (ages 10-30)

Question 30

Signs and symptoms of perforation of a diverticular abscess

Answer 30

Generalized peritonitis, abdomen distended and very tender, rigidity

Bowel sounds absent

Perforation seen on CT (free air supine - crescent sign)