General Medicine

Question 1

What is diverticulitis?

Answer 1

perforation of a diverticulum due to diverticular inflammation and focal necrosis

Question 2

what is a diverticulum?

Answer 2

sac-like protrusion of the colonic wall

Question 3

what is diverticulosis?

Answer 3

merely describes teh presence of diverticula

Question 4

what are some associated complications with diverticulitis that make it “complicated” diverticulitis?

Answer 4

bowel obstruction
abscess
fistula
perforation

Question 5

what is the mean age at admission for acute diverticulitis?

Answer 5

63 y/o

Question 6

what is the most common CC for a patient with acute diverticulitis?

Answer 6

abdominal pain- usually in the Lower left quadrant due to involvement of the sigmoid colon

Question 7

What are some S/S suspicious of acute diverticulitis?

Answer 7

abdominal pain- LL quadrant
nausea, vomiting
low grade fever

Question 8

What are some signs of peritonitis that are worrisome in a patient you suspect with acute diverticulitis?

Answer 8

hemodynamic instability - hypotension

localized abdominal guarding, rigidity, and rebound tenderness

Question 9

what imaging would you get on someone with abdominal pain?

Answer 9

abdominal ultrasound or abdominal CT

Question 10

what type of fistula is most commonly seen in someone with suspected acute diverticulitis?

Answer 10

bladder- colovesical fistual

Question 11

what findings would you see on abdominal CT/ultrasound suggestive of acute diverticulitis?

Answer 11

bowel wall thickening (>4mm)
presence of diverticula
possible abscess with free air

Question 12

What are some DDx for someone complaining of abdominal pain?

Answer 12

colorectal cancer
acute appendicitis
IBD
diverticulitis
infectious colitis 
ischemic colitis

Question 13

should you perform endoscopic evaluation in the setting of possible acute diverticulitis?

Answer 13

NO- it is contraindicated due to the risk of perforation or exacerbation of the existing inflammation
*standard practice is to perform a colonoscopy 6 wks after recovery to rule out colorectal cancer

Question 14

empiric antibiotic treatment for patients with complicated diverticulitis should provide coverage for what?

Answer 14

Gram (-) and anaerobic pathogens

Question 15

what IV antibiotic regimen would you start for someone with suspected acute diverticulitis?

Answer 15

1. Unasyn (3g IV q 6hrs) or Zosyn (3.375g IV q 6hrs) or Timentin (3.1 g IV q6hrs)
2. Ceftriaxone (1g IV q 24hrs) + metronidazole (500mg IV q 8 hrs)

Question 16

what are some DDx for someone presenting with diarrhea?

Answer 16

antibiotic-associated diarrhea
acute abdomen
non-infectious diarrhea: IBD, IBS, celiac disease

Question 17

What type of diarrhea is associated with C. diff infection?

Answer 17

watery diarrhea

Question 18

Why does someone get C. diff colitis?

Answer 18

colonizes teh human intestinal tract after the normal gut flora has been altered by antibiotic therapy

Question 19

which abx are frequently implicated in C. diff infection?

Answer 19

clindamycin
fluoroquinolones
cephalosporins
penicillins

Question 20

how do you confirm your diagnosis for someone with a C. diff infection?

Answer 20

stool test for C. diff TOXINS

Question 21

What are the management principles for someone with C. diff infection?

Answer 21

1. stop the offending antibiotic ASAP
2. contact precautions
3. empiric abx therapy with ORAL metronidazole or oral vancomycin

Question 22

What is first-line DOC for C. diff infection?

Answer 22

oral Vancomycin (125 mg qid)  for 10-14 days 
or oral Metronidzole (500mg tid)

Question 23

Why is oral vancomycin drug therapy ideal for C. diff infection?

Answer 23

bc oral vancomycin is not absorbed systemically and achieves predictably high levels in the colon to act at the site of infection (vanco is superior to Metronidazole)
*vanco cannot be given IV because it is not excreted into the colon