Term
| intial imaging study of choice with diverticulitis: |
|
Definition
|
|
Term
| when should colonscopy be done with diverticulitis? |
|
Definition
- NOT during acute flare
- wait for 6 weeks and then do one to rule out cancer and IBD |
|
|
Term
| Typical findings on abdominal CT with diverticulitis: |
|
Definition
- thickening of bweol wall
- fistulas
- abscess |
|
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Term
| Eval of diverticulitis bleeding: |
|
Definition
| - if greater than 1 mL/min> ARTERIOGRAPHY- can infuse vasopressin to arteries causing bleed and do selective arterial emobolization, but its expenseive and invasive) |
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Term
| Non-pharmacologic treatment of diverticulitis: |
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Definition
| - increase fiber intake and exercise |
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Term
| Severe diverticulitis tmt: |
|
Definition
- nothing by mouth
- IV hydration
- NG suction if ileus or small bowel obstruction is present |
|
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Term
| Treatment for mild diverticulitis: |
|
Definition
- liquid diet 7-10 days
- Ciprofloxacin 500 mg bid + Metronidazole 500 mg q6h
(cipro for aerobes, metro for anaerobes)these are considered broad spectrum |
|
|
Term
| Severe Diverticulitis tmt: |
|
Definition
- NPO and IV antibiotics:
- Ampicillin-sulbactam
- Piperacillin-tazobactam
- Ciprofloxacin and Metronidazole
- Cefoxitine and Metronidazole |
|
|
Term
| Life threatening diverticulitis tmt: |
|
Definition
- Imipenem 500 mg IV q6h
- Meropenum 1g IV q8h |
|
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Term
| Surgery for diverticulitis should be considered when: |
|
Definition
- Repeated episodes of diverticulitis (2 or more)
- Failure to respond to conservative management
- Abscess/fistula formation
- Obstruction
- Peritonitis
- Immunocompromised pts
- First episode in young pt less than 40 y/o
- Inability to rule out carcinoma |
|
|
Term
| Percentage of patients with diverticulitis that eventually require surgery? |
|
Definition
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Term
| An intra-abdominal abscess is a localized collection of pus confined in the __ __ by an __ __. |
|
Definition
- peritoneal cavity
- inflammatory barrier |
|
|
Term
| Origin of intra-abdominal abscess: |
|
Definition
- from bacteria that colonize the intestines- usually mix of aerobe and anaerobes
ANTIBIOTICS NOT EFFECTIVE B/C THE ABSCESS IS NOT VASCULARIZED |
|
|
Term
| Causes of Intra-abdominal abscesses: |
|
Definition
- Perforation of viscus
- Perforation of peptic ulcers
- Peforated appendicitis and diverticulitis
- Gangrenous cholecystitis
- Mesenteric ischemia with bowel infarction
- Pancreatitis or pancreatic necrosis progressing to pancreatic abscess
- Blunt trauma |
|
|
Term
| Risk factors for intra-abdominal abscess formation: |
|
Definition
- Pre-existing organ dysfunction
- Underlying malignancy
- Transfusion
- Chronic steroid use
- Increasing age
- Malnutrition |
|
|
Term
| Intra-abdominal abscess presentation suggestive symptoms: |
|
Definition
- persistant abdominal pain
- focal tenderness
- spiking fever
- persistent tachycardia
- prolonged ileus
- leukocytosis
- intermittent polymicrobial bacteremia |
|
|
Term
| Possibly the only initial clues of intraabdominal abscess: |
|
Definition
- peristent fever
- mild liver dysfunction
- persistent GI dysfucntion
- nonlocalizing debilitating illness |
|
|
Term
| Blood cultures indicating persistent polymicrobiral bacteremia strongly implicate the presence of: |
|
Definition
| - intra-abdominal abscess |
|
|
Term
| More than 90% of intra-abdominal abscesses contain ___ organisms, particularly __ ___. |
|
Definition
|
|
Term
| Post-operative ___ species bacteremia strongly suggests __ __. |
|
Definition
- Bacteroides
- intraabdominal sepsis |
|
|
Term
| X-rays are not diagnostic of abscesses, but may indicate need for further work up. What are some findings tha may make you want to investigate possiblity of absces on x-ray: |
|
Definition
- localized ileus
- extaluminal gas
- air-fluid levels
- mottled-soft tissue masses
- absence of psoas outlines
- displacement of viscera
chest radiograps with subphrenic or subhepatic abscess:
- pleural effusion
- elevated hemidiaphragm
- basilar infiltrates
- atelectasis |
|
|
Term
| Best test for imaging of intra-abdomminal abscess: |
|
Definition
| CT with IV and oral contrast |
|
|
Term
| choices for draining intra-abdominal abcess: |
|
Definition
- First choice: percutaneous CT guided catheter drainage
- Surgical (laparoscopic or open) drainage |
|
|
Term
| Palpable tender, fluctuant mass impinging on the vagina or rectum: |
|
Definition
- pelvic abscess
- best to drain transvaginally or transrectally |
|
|
Term
|
Definition
|
|
Term
|
Definition
- one internal opening
- one opening on the skin |
|
|
Term
|
Definition
| - tubes of skin that are open on the outside but closed on the inside and do not connect to any internal structure |
|
|
Term
|
Definition
| - complex fistulas with more than one opening on the exterior of the body |
|
|
Term
| explain etiology os anal fistula: |
|
Definition
| anal gland inflammation> inflammation moves into muscle> abscess forms> half the time abscess becomes fistula |
|
|
Term
| SI and LI fistulas are associated with: |
|
Definition
|
|
Term
| __% of gastric fistulas are iatrogenic> |
|
Definition
|
|
Term
| 80% of SI fistulas are from __ __. |
|
Definition
|
|
Term
| Colonic fistulas mostly come from __ __ but can also occur after surgery for an inflammatory condition. |
|
Definition
| intra-abdominal inflammation |
|
|
Term
| Risk Factors for Fistula formation: |
|
Definition
- Malignancy (especially gynecological or pancreatic)
- Radiation
- IBD
- Diverticular Diseases
- Appendicitis
- Perforation of abdominal ulcer
- Surgery for cancer, IBD, adhesions, or PUD
- Aortic aneurysm
- Infected aortic graft
- Previous abdominal aortic surgery
- Abdominal trauma (gunshot, stab, MVA) |
|
|
Term
| Symptoms of gastrocolic fistula: |
|
Definition
- abdominal pain
- weight loss
- feculent belching |
|
|
Term
| Enterovesical and Colovesical fistula symptoms: |
|
Definition
- pneumaturia (air in urine stream)
- fecaluria (stool in urine stream)
- recurrent UTIs |
|
|
Term
| Rectovaginal or Anovaginal fistula symptoms: |
|
Definition
- may be asymptomatic or only have symptoms with liquidly stools
- inadvertant passage of stool or gas
- dyspareunia
- perineal pain |
|
|
Term
| Aortoenteric fistulas present with: |
|
Definition
|
|
Term
| Lab studies performed with fistulas: |
|
Definition
- Serum studies: Albumin, Prealbumin, BUN, Creatine, Electrolyes(APBCE)
- Abscess cultures
- UA or urine culture for colovescial fistulas |
|
|
Term
| Imaging study of choice for fistulas: |
|
Definition
|
|
Term
| test to help delineate extend of communication of fistula with underlying bowel: |
|
Definition
|
|
Term
| Test to help ID fluid collections along fistula tract: |
|
Definition
|
|
Term
| Test that may be helpful in determine cause of fistula: |
|
Definition
| Barium enema and small bowel series |
|
|
Term
| Test that is helpful in determing the presence of possible enterovesicle fistula: |
|
Definition
| Cystography and CT cystography |
|
|
Term
| Fistulas involving the __ or __ need to be referred to a surgeon. |
|
Definition
|
|
Term
| diet management with fistulas: |
|
Definition
|
|
Term
| Meds given in management of fistulas: |
|
Definition
- somatostatin analogs _ inhibt release of serotonin and hormones involved in GI function
- immunosuppressive agents |
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