Lower GI Infections: Appendicitis, Diverticulitis, CDiff

Question 1

Appendicitis

-presentation

Answer 1

EG dull => RIF localised pain
Fever
N+V, constipated

Perforation - guarding, rebound
Palpable abscess

Rovsings => LIF palpation leads to RIF pain
Psoas => pain extending right hip due to irritation to psoas

Question 2

Appendicitis

-diagnosis and key investigations

Answer 2

High CRP + compatible history and exam = clinical diagnosis

FBC - neutrophilia
U&E, LFT - routine
Amylase - rule out pancreatitis

Rule out other differentials
Abdo US - rule out pelvic causes
-urinedip - UTI
-pregnancy test - ectopics

Question 3

Appendicitis management

• uncomplicated
• acutely unwell/septic.perforated

Answer 3

Uncomplicated
-preop ABx => appendectomy

Acutely unwell/septic/perforated

• IMMEDIATE - fluid resus, ABx
• DEFINITIVE - appendectomy + postop ABx

Consider Abx therapy if minimal signs and patient is well

Question 4

Diverticulosis vs diverticulitis

• presentation
• pathophysiology

Answer 4

Herniation of colon mucosa through muscle colon wall in sigmoid
-inflammation of outpouchings => perforation, fecal peritonitis, abscess

In older adults
-constant LIF (no peristalsis involved in pain)
Fever
N+V, constipated

Question 5

Diverticulitis

• Investigations
• Management

Answer 5

DEFINITIVE - CT
-look for abscess

• FBC - high WCC
• high CRP
• Erect CXR - pneumoperitoneum

Mx - ABx, analgesia, liquid diet

Mild - PO ABx
Severe - IV ABx
Perforation - surgery

Prevention
-high fibre, physical activity

Question 6

CDiff

• pathophysiology
• risk factors
• presentation

Answer 6

G+ => pseudomembranous colitis in large bowel
Normal gut flora suppressed by broad spec ABx
-clindamycin
-cephalosporins
-ciprofloxacin
-coamox

Diarrhoea, abdo pain, high WCC

Question 7

CDiff

• diagnosis, investigation
• management

Answer 7

Definitive - CDiff TOXIN in stool
-antigen only shows exposure, not current infection

STOP ABx IF POSSIBLE
1st line - PO vancomycin　10days

Question 8

CDiff complications

Answer 8

Dehydration, AKI => from diarrhoea fluid loss

Toxic megacolon - inflammation affects smooth muscle => paralysis and dilation
-constipation
-abdo distension
May need colectomy, stoma

Perforation, peritonitis