Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med GI PART 1 > Appendicitis, Diverticulitis > Flashcards

Appendicitis, Diverticulitis Flashcards

(87 cards)

Start Studying
1
Q

Appendix, is mobile in the _____

A

RLQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

2 most common position for appendicitis

A

Pelvic

Retrocecal, behind cecum, most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Appendicitis, has a peak incidence in _______

A

Adolescents 11-18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Overall appendicitis most commonly occurs in ___ and ____ decade of life

A

2nd and 3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Children or adults have the highest risk for a perforation

A

Children have the highest risk for a perforation,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Primary cause of appendicitis is

A

Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common factor which leads to an obstruction in a adult causing appendicitis

A

Facilith, fecal stone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mc cause for obstruction leading to appendicitis in children

A

Lymphoid hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathophys appendicitis

A
  1. Obstruction
  2. Bacterial overgrowth
  3. Distention activates periumbilical pain
  4. Inflammation triggers right lower quadrant pain 12 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical presentation of appendicitis

A
  1. Anorexia
  2. Periumbilical pain, epigastric pain
    3, later migration to the, right lower quadrant, abdomen, (12-18 hours later)
  3. Nausea
  4. Vomiting
  5. Fever( late)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Children may have classic presentation, but may have absense of migratory pain or fever, what are two other indicators

A

Lay in bed with minimal movement
Infant, might flex right leg over the abdomen

Change in bowels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rebound tenderness. Is worsening of pain, after releasing pressure, this inidicates what

A

Peritonitis, possible rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pregnant patient with appendicitis less likely to have clinical presentation of appendicitis true or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pregnant patients with appendicitis has less _____ pain

A

Parietal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Guarding is when abdominal muscle tenses up and can indicate

A

Peritonitis and ruptured appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gold standard appendicitis imaging

A

CT ABDOMEN AND PELvis

Will show enlarged appendic >6, wall thickening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Preferred diagmostic imaging in children and pregnant women for appendicitis

A

Ultrasound,

Show noncompressible appendices
Enlarged

And then could do a mri if need more data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Non perforated appendix (early uncomplicated)treatment is

A

Appendectomy
Done within 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Initial tx management for appendicitis

A

Pain management
Bowel rest
Correct dehydration
Correct electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What must be done pre op before appendectomy

A

Must do iv antibiotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Of pt refuses or is unfit for surgery in uncomplicated appendicitis what is treatment

A

Iv antibiotics, and in hospital observation,
If improved 10 day course of antibiotics

If no improvement then do immediate appendectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Perforated, complicated appendicitis, hemodynamically unstable pt what is treatment

A

Emergency appendectomy, plus 3-4 days iv ABX
Irrigation and drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If a stable perforatuon appendix, such as seen on imaging and less than 3 cm what is treatment

A

Emergency appendectomy plus 3-5 days of iv antibiotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If a stable perforatuon appendix, such as seen on imaging and greater than 3 cm what is treatment

A

Percutaneous drainage and iv antibiotics

If improved, 7-10 po ABX and discharge

No improvement appendectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Antibiotic choice for appendicitis
Cephalosporin (1-2g) and metronidazole, 500 mg iv Cefazolin or ceftriaxone Or Levofloxacin and metro
26
Biggest complication of appendicitis
Perforation Leads to peritonitis
27
What is diverticulosis
Presence of diverticula, usually is asymptomatic
28
Symptomatic diverticulosis and with inflammation is known as
Diverticulitis
29
What area is most commonly affected by diverticulum
Sigmoid
30
Diverticulosis, risk increased with ___
Age
31
High incidence of diverticulosis in the _____ colon
Left
32
Most pts with diverticulosis are asymptomatic, true or false
True
33
Right colon in diverticulosis is most common for bleeding, true or false?
True. Right colon most common for a bleed
34
Risk factor diverticulosis, diverticulitis
Low fiber Red meat, increases incidence Physical inactivity Obesity Constipation Ehlos danlos disease, Marfan, hiv
35
Diverticulitis occurs when there are _______ to the diverticulum which lead to inflammation
Perforations
36
Diverticulosis clinical presentation
Usually asymptomatic May have painless hematochezia, blood in the stool
37
Diverticulitis clinical presentation
Left lower quadrant pain, abdominal pain No rectal bleed but may be Guiac positive , no red blood, tho just due to minor perforatuon Low grade fever Distention Change in bowel habits
38
What could be mistaken for appendicitis , due to rlq pain
Right sided diverticulitis
39
What are clinical indications of diverticular hemmorhage
Tachycardia and hypotension
40
Physical exam diverticulitis
Left lower quadrant pain, tenderness, Guiac may be positive, but blood present in rare Tender palpable mass, 20% Often palpable tender mass
41
Test of choice for diverticulosis
Colonoscopy
42
What test never done for diverticulitis due to perforation risk
Colonoscopy
43
Test of choice diverticulitis
Ct abdomen, WITH CONTRAST
44
Other differential for left lower quadrant pain
Crohns C diff Ibs Colorectal cancer
45
Complications of diverticulitis
Absecs (fever greater than 3 days) Perforation, *look for guarding, rebound tenderness, rigidity Obstruction, narrowing due to inflammation, Fistula, dysuria, fecaluria
46
Tx diverticulosis *asymptomayic
High fiber Monitor
47
Tx diverticulosis, if bleed or hemmorhage
Most stop spontaneously, if severe, can do iv fluid , blood or endoscopic therapy
48
Uncomplicated diverticulitis tx
Clear liquid diet Pain management, ibuprofen or acetaminophen Follow up weekly, Colonoscopy, done after symptoms have resolved, (typically 4-6 weeks); If immunocomprised, need ABx, cipro plus metronidazole
49
Complicated diverticulitis inpatient criteria
Need only 1 Sepsis Over 70 Comorbities, such as diabetes High fever, Complicated diverticulitis, perforation, or abscess, Immunosuppressed
50
Pt with uncomplicated diverticulitis but has hiv what is tx
Clear liquid diet Pain management, ibuprofen, acetaminophen **** ABX, cipro and metronidazole 500 , PO
51
Diverticulitis, once resolving symptoms must have what done
Colonoscopy, 4-6 weeks
52
Diverticulitis inpatient treatment
Npo or clear liquids ABX Low risk, zosyn High risk Cephalosporins and metro
53
Diverticulitis with absecc , greater than 3 cm
CT guided percutaneous drainage
54
Diverticulitis with absecc , less than 3 cm
Iv ABX
55
Small intestine 2 arteries
Celiac artery Superior mesenteric artery
56
Which artery supplies all of small intestine except proximal duodenum
Superior mesenteric artery
57
What artery provides collateral flow when the small mesenteric artery is compromised
Celiac artery
58
What arteries supply large intest8en
SMA, right side IMA, left
59
2 areas of weakness in large intestine
Splenic flexure Rectosigmoid junction
60
Acute mesenteric ischemia definition
Acute sudden onset of small intestinal hypoperfusion
61
Mesenteric ischemia
Ischemia of small intestine
62
Colonic ischemia is
Ischemia of large intestines
63
Acute mesenteric ischemia most common cause is
Arterial Embolism , from heart to the superior mesenteric artery
64
Acute mesenteric ischemia other cause is
Arterial thrombosis, In a patient with atherosclerosis, PAD Venous, thrombus, idiopathic, or malignancy, prior surgery Non occlusive ischemia, low flow state, due to shock, MI, CHF, usually Ill patient on multiple drugs that reduce intestine perfusion
65
Acute mesenteric ischemia history,
1/3 of patients had a prior embolism mesenteric ischemia, Or have a history of DVT or PE,
66
67
Acute mesenteric presentation
Sudden and severe constant abdominal pain —— - Usually epigastric but can be poorly localized Vomiting and diarrhea No blood in stool
68
Exam for acute mesenteric ischemia
Ill appearing, No exam findings PAIN OUT OF PROPORTION TO AMOUNT PALPATED
69
Ischemia injury depends on perfusion and adequate collateral circulation Doesn’t occur until, perfusion pressure r3duc3 to ___ mmhg
30
70
Chronic mesenteric ischemia epidemiology, who does it affect
>90% are elderly >60 years old Females more impacted than males, History of tobacco use
71
Chronic mesenteric ischemia symptoms
Dull and crampy pain RECCURENT worse after meals, subsides after 2 hours Weight loss
72
Physical exam for chronic mesenteric ischemia
Epigastric Abdominal bruit Might be tender
73
Acute colonic ischemia epidemiology
Most are elderly , >60 , and with chronic disease, CHF, and MI
74
Acute colonic ischemia symptoms
Sudden mild and crampy abdominal pain Rectal bleeding. Bloody diarrhea LLQ pain Urge to move bowels
75
Acute colonic ischemia exam
LLQ and lateral tenderness to palpation
76
Acute colonic ischemia and diverticulosis how do they present similar to differentiate
Both have rectal bleeding , or could Acute colonic ischemia, also has LLQ pain, crampy and sudden
77
Lab work for ischemia
CMP will show metabolic acidosis CBC, leukocytosis with a left shift
78
Initial test for ischemia
CT abdomen with angiography No contrast, Done to assess vessels,
79
Gold standard diagnostic to confirm and treat mesenteric disease
Catheter based angiography
80
Confirm ischemia colitis in a pt with no sign of peritonitis or perforation is
Colonoscopy
81
Mesenteric ischemia Ct findings
Bowel wall thickening Bowel dilation Target sign, May have fat stranding in peritoneal cavity
82
Colonic ischemia ct finding
Thumbprint sign bowel wall thickening and edema
83
Treatment for acute mesenteric ischemia Embolism, Venous thrombosis Arterial thrombosis Non occlusive ischemia
Embolism, laparotomy, with embolectomy Arterial thrombosis, angioplasty with stenting Venous thrombosis, (look for prior hypercoagulable state) surgery, idiopathic, malignant *Anticoagulation Non occlusive ischemia, treat cause, and vasodilator
84
Tx for acute mesenteric ischemia involves what
Revascularization and remove necrosis
85
If signs of perforation (free air on imaging is seen) , gangrene, or necrosis suspected due to extensive pain in acute mesenteric ischemia what may need to be done
Explore laparotomy with a bowel resection
86
Tx for acute ischemic colitis
Restore perfusion, most is non occlusive Treat underlying cause, same as acute mesenteric ischemia
87
Chronic mesenteric ischemia tx
Asymptomatic, aspirin, smoke cessation Symptomatic, revascularization, open or endovascular

Clin Med GI PART 1 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions