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Flashcards in General Medicine Deck (23):
1

What is diverticulitis?

perforation of a diverticulum due to diverticular inflammation and focal necrosis

2

what is a diverticulum?

sac-like protrusion of the colonic wall

3

what is diverticulosis?

merely describes teh presence of diverticula

4

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

bowel obstruction
abscess
fistula
perforation

5

what is the mean age at admission for acute diverticulitis?

63 y/o

6

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

7

What are some S/S suspicious of acute diverticulitis?

abdominal pain- LL quadrant
nausea, vomiting
low grade fever

8

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

9

what imaging would you get on someone with abdominal pain?

abdominal ultrasound or abdominal CT

10

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

bladder- colovesical fistual

11

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

12

What are some DDx for someone complaining of abdominal pain?

colorectal cancer
acute appendicitis
IBD
diverticulitis
infectious colitis
ischemic colitis

13

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

14

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

Gram (-) and anaerobic pathogens

15

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)

16

what are some DDx for someone presenting with diarrhea?

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

17

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

watery diarrhea

18

Why does someone get C. diff colitis?

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

19

which abx are frequently implicated in C. diff infection?

clindamycin
fluoroquinolones
cephalosporins
penicillins

20

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

stool test for C. diff TOXINS

21

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

22

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

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

23

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

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