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Diverticulosis, Diverticulitis and Appendictis
NA
50
Medical
Graduate
09/15/2010

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Term
What is herniations of colonic mucosa/submucosa through the muscularis propria and occurs at perforating arteries transverse the circular muscle layer
Definition
Colonic diverticulosis
Term
Where predominatly does diverticulosis occur in the bowel?
Definition
L colon-sigmoid colon
Term
95% of the cases of diverticulosis the ___colon and ____segments are involved
Definition
sigmoid, proximal
Term
What percentage of people with diverticulosis will develop diverticulitis?
Definition
10-25%
Term
What sex is more likely and what race to get diverticulosis/itis?
Definition
women/blacks
Term
What kind of diet is diverticulosis common in
Definition
low fiber
Term
What percent of diverticulitis patients are asymptomatic?
Definition
80%
Term
How do we diagnose diverticulitis?
Definition
barium enema/endoscope
Term
What is the differential for Diverticulitis?
Definition
IBS, IBD (i.e. Crohns is R sided UC is Left sided) Ischemic colitis, Colorectal cancer
Term
Acute diverticulitis: when mild, there is limited inflammation and pain in ___ ____abdomen, localized tnderness, fever, anorexia and Nasea ____vomiting
Definition
Left lower without
Term
When diverticulits is more sever, we see _____or abscess within pericolic fat, mesentery or pelvis
Definition
Phlegmon
Term
In severe diverticulitis there are these openings that can form between structres? What are they and where do they occur?
Definition
Fistulas between bowel/bladder
Term
The differential Diagnosis for diverticulitis is broad name some of the other diseases it can be
Definition
appendicitis, mesenteric adenitis, Crohns disease, Meckels diverticulitis, omental torsion, pepetic ulcer, etc.
Term
Women of childbearing age with suspected diverticulitis should be screened for what things?
Definition
PID, rupture of ovarian follicle,ectopic prgnancy
Term
When evaluating the diverticuitis patient what will be elevated in CBC? What test is CONTRAINDICATED IN THESE PATIENTS? What test should be ordered instead?
Definition
increased WBC, Barium enema is a no no, use CT scan or Ultrasound
Term
What diet do we put the mild diverticulitis patient on?
Definition
Liquid, when symptoms quit, then advance to high fiber slowly
Term
What antibiotics should be given to our mild diverticulitis patient?
Definition
Augmentin, Double strength trimethoprimsulfamethaxazole, sipro, Flagyl
Term
What antibiotics should be given to our more severe diverticulitis patient?
Definition
gram negative aerobic/gram negative anaerobic: Ampicillin-sulbctam (Unasyn) and piperacillintazobactam (Zosyn)
Term
According to Dr. Leondhart, when do we get a surgury consult on these patients w/ diverticulitis?
Definition
right away
Term
What are the complications of diverticular disease? There are three!
Definition
fistulas solonic stricture, diverticular bleeding
Term
What percent of diverticular patients will get a fistula?
Definition
10-15%
Term
What fistula accounts for 50-65% of diverticular fistulas?
Definition
Colon-bladder
Term
What percent of diverticular patients will have diverticular bleeding?
Definition
15-56%
Term
What is the prophylaxis and treatment of Diverticulitis/osis?
Definition
more fiber!!!
Term
What has an incidence of 1/1000 per year in the USA?
Definition
Appendiciis
Term
What is the lifetime risk of appy for men and women?
Definition
9/7%
Term
What is the pathogenesis of appy's? What gets obstructed?
Definition
Lumen
Term
What percent of appy pateints complain of pain intially referred to epigastium and periumbilical and then moves to RLQ
Definition
90%
Term
When you suspect a patient has an appy, what percent will have anorexia? and if they are vomiting what should you think that is suggestive of?
Definition
80-90% and another diagnosis
Term
There will be tenderness in RLQ in what percent of patients?
Definition
90%
Term
What are the 2 atypical presentations of appys? (i.e. what position is appy in?)
Definition
retrocecal and plvic
Term
In pregnancy how many will have an appy?
Definition
1/766
Term
In appys, what percent of patients will have an increased WBC count?
Definition
90%
Term
What test should be given to women of child bearing age when present w/ s/s of appy?
Definition
pregnancy test
Term
Treatment of appy's: what needs to be done as soon as you suspect and confirm appendicitis?
Definition
prompt surgical removal
Term
When pre-op'ing the patient what medication is given and for how long post op?
Definition
ampicillin sulbactam or cephalosporin, 7-14 days post op
Term
What percent of patients w/ simple appys will have complications? What percent with perforation will have complications?
Definition
5% and 30-50%
Term
What are the most common complications of appys?
Definition
wound infections and intra abdominal abscess, intestinal obstruction and prolonged ileus
Term
What is the most common gastrointestinal motility disorders? There are 4
Definition
Nonulcer dyspepsia, IBS, functional constipation and outlet obstruction to defecation
Term
Liquids empty from stomach w/ a half-emptying time of how many minutes or less?
Definition
20
Term
What size are particles are let into the duodenum?
Definition
<2mm
Term
What is the name of the syndrome where a too tight of repair of hiatal hernias results in dysphagia, abdominal pain, gas bloating, dyspeptic condition?
Definition
postfundoplication syndrome
Term
What is this motility disorder being described? upper abdominal postprandial symptoms, w/ nausea, vomiting, pain, bloating anorexia, early satiety
Definition
nonulcer dyspepsia
Term
What percent of population has nonulcer dyspepsia?
Definition
20%
Term
If dysphagia, bleeding, and weight loss are present, we must rule out what?
Definition
malignancy
Term
How do we treat nonulcer dysphagia?
Definition
PPI/H2 blockers and treat H. pylori if present
Term
What is THE MOST COMMONLY DIAGNOSED FUNCTIONAL DISORDER OF GI TRACT?
Definition
IBS
Term
What is the syndrome being described here? abdominal pain and altered bowel movements, pain often worse after eating, in lower quadrants or hypogastium and is aggravated before and relieved by BM
Definition
IBS
Term
What tests do we order to exclude organic disease in IBS?
Definition
Stool exam and occult blood, blood tests, serologic tests for celiac, sigmoidoscopy and if older than 45 do barium enema/solonoscopy
Term
What is the treatment for IBS?
Definition
Fiber and psychotherapy
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