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11 Cards in this Set
- Front
- Back
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What are the 3 pains of appendicitis?
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Visceral in the periumbilical region
Transmural inflammation --> pain localized to RLQ "McBurney's Point" If perforation occurs, peritonitis ensues --> diffuse abdominal pain “Peritoneal signs” |
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What imaging tests are used to dx Appendicitis?
What is seen? Why are these imaging tests done? |
Ultrasound
CT w/contrast dilated, fluid filled appendix with thick wall; inflammation in fat surrounding appendix really to rule out other dz - you'll still probably go to the OR w/ the appropriate clinical picture. |
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How do we tx appendicitis?
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Broad spec antiB
surgery |
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Diverticular dz can be either complicated or uncomplicated.
What are the two major complications? Can they coexist? What is diverticulosis? - on which side does it usually occur? Pseudodiverticulum? |
Diverticulitits
Diverticular hemorrhage/bleeding No. The condition of having diverticulae. - left-sided, non-rectal herniation of mucosa and submucosa through muscular layer of colon. |
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Which of the two complications of diverticulosis can manifest with abscesses and fistulas? Pathogenesis?
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diverticulitis
- Feces becomes inspissated w/i diverticulum --> fecolith abrades mucosa --> chronic low grade inflammation --> perforation (micro or macro) |
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Abdominal pain (left lower quadrant)
Fever Constipation Leukocytosis Bowel obstruction Peritoniteal signs NO bleeding NO diarrhea ... this describes the presentation of which complication of diverticulosis? |
diverticulitis
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What are some of the complications of:
microperforation (diverticulitis)? macroperforation (diverticulitis)? |
Localized phlegmon
Segmental narrowing Stricture Obstruction Peritonitis Abscess Fistulas |
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What sort of imaging is done to look for diverticulitis? Is anything specifically contraindicated?
How is the dz managed? |
CT
Colonoscopy, barium enema. - can turn a micro --> macro Clear liquid diet or NPO if dz is too complicated AntiB actv against Gram-neg & anaerobes |
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How do you evaluate pts with Bacterial enteritis?
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For systemic toxicity, severe pain, dehydration, or bloody stools, or if symptoms persist more than 24 hours:
- Stool studies, including fecal leukocytes, ova and parasites, and occult blood; Clostridium difficile toxin (e.g., if recent antibiotic use) - CBC with differential, blood culture - Serum electrolytes if needed to manage dehydration |
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What is Pseudomembranous Colitis?
- principal pathogen? - strong associations? - what is produced? (2) + which is a direct cytotoxin? + which is an enterotoxin? |
special type of bacterial enteritis
- c. diff - antiB (esp clindamycin) - hospitalization - two toxins (A and B) + A is an enterotoxin (causes mucosal inflammation and inappropriate colonic secretion), B is a direct cytotoxin |
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Diarrhea, crampy abdominal pain, usually after initiation of antibiotics
Inflammatory diarrhea, with small amounts of blood in it Leukocytosis (~15K) Severe cases: Fevers, chills, abdominal distension ...this describes the presentation of which dz? How is this dz dx'ed? Managed? - should antidiarrheals be used? |
Pseudomembranous colitis
Stool for C diff toxin Detects toxin A Can miss strains that only produce toxin B Stool culture not routinely performed Endoscopy: pseudomembranes remove/stop offending agent - NO! Metronidazole Vancomycin |
