Flashcards in General Medicine Deck (23)
What is diverticulitis?
perforation of a diverticulum due to diverticular inflammation and focal necrosis
what is a diverticulum?
sac-like protrusion of the colonic wall
what is diverticulosis?
merely describes teh presence of diverticula
what are some associated complications with diverticulitis that make it "complicated" diverticulitis?
what is the mean age at admission for acute diverticulitis?
what is the most common CC for a patient with acute diverticulitis?
abdominal pain- usually in the Lower left quadrant due to involvement of the sigmoid colon
What are some S/S suspicious of acute diverticulitis?
abdominal pain- LL quadrant
low grade fever
What are some signs of peritonitis that are worrisome in a patient you suspect with acute diverticulitis?
hemodynamic instability - hypotension
localized abdominal guarding, rigidity, and rebound tenderness
what imaging would you get on someone with abdominal pain?
abdominal ultrasound or abdominal CT
what type of fistula is most commonly seen in someone with suspected acute diverticulitis?
bladder- colovesical fistual
what findings would you see on abdominal CT/ultrasound suggestive of acute diverticulitis?
bowel wall thickening (>4mm)
presence of diverticula
possible abscess with free air
What are some DDx for someone complaining of abdominal pain?
should you perform endoscopic evaluation in the setting of possible acute diverticulitis?
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
empiric antibiotic treatment for patients with complicated diverticulitis should provide coverage for what?
Gram (-) and anaerobic pathogens
what IV antibiotic regimen would you start for someone with suspected acute diverticulitis?
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)
what are some DDx for someone presenting with diarrhea?
non-infectious diarrhea: IBD, IBS, celiac disease
What type of diarrhea is associated with C. diff infection?
Why does someone get C. diff colitis?
colonizes teh human intestinal tract after the normal gut flora has been altered by antibiotic therapy
which abx are frequently implicated in C. diff infection?
how do you confirm your diagnosis for someone with a C. diff infection?
stool test for C. diff TOXINS
What are the management principles for someone with C. diff infection?
1. stop the offending antibiotic ASAP
2. contact precautions
3. empiric abx therapy with ORAL metronidazole or oral vancomycin
What is first-line DOC for C. diff infection?
oral Vancomycin (125 mg qid) for 10-14 days
or oral Metronidzole (500mg tid)