Appendicitis and Diverticulitis
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 2 June 2019
⏱️ 26 minutes
🔗️ Recording | iTunes | RSS
🧾️ Download transcript
Summary
Appendicitis
History
Vague nonspecific abdominal cramping and nausea (Nonspecific Phase) gradually progresses to localized pain (Localized Phase). The pain most commonly localizes in the RIGHT LOWER QUADRANT near McBurney’s Point.
Exam
* Focal tenderness in the right lower quadrant* McBurney’s Point: 1/3 the distance traveled from anterior superior iliac spine (ASIS) to the navel. * Psoas Sign: Pain with hyperextension of the right hip (while patient is laying on left side)* Obturator Sign: Pain when flexing right hip to 90 degrees and rotating* Rovsing Sign: Pain felt in the right lower quadrant when pushing on the left lower quadrant
Testing
Fact 1: The urinalysis can be abnormal in appendicitis
Fact 2: The white blood cell count can be normal in appendicitis
As far as imaging when appendicitis is suspected…
* Most people get a CT scan * Most pregnant women get MRI * Most pediatric patients get an ultrasound
Treatment
* Analgesia (example- 4mg IV morphine)* Antiemetics (example- 4mg IV ondansetron… aka Zofran)* Antibiotics (example- 4.5mg IV piperacillin/tazobactam.. aka Zosyn aka “pip-tazo”)
Diverticulitis
History
Similar to appendicitis. Vague nonspecific cramping and nausea gradually progressing to localized pain. This pain most commonly is located in the LEFT LOWER QUADRANT. Stool related complaints such as constipation and bleeding also common
Exam
Tenderness in the left lower quadrant
Testing
Easy… Get a CT scan
Treatment
If the patient has severe symptoms, big risk factors such as immunosuppression, or complications of diverticulitis (abscess, perforations, etc). Treat the same as appendicitis… Admit, antibiotics, surgery consult
If the patient has mild symptoms, they commonly are sent home on oral antibiotics and close follow up.
Additional Reading
* American college of radiology imaging options for appendicitis (ACR)* American college of radiology imaging options for diverticulitis (ACR)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast. |
| 0:10.3 | Over the last few weeks, we've been working on a presentation-based approach to abdominal pain. Remember, abdominal pain is probably the single most high-yield area of study that you can do for your |
| 0:21.0 | emergency medicine clerkship. |
| 0:22.8 | Abdominal pain is the most common chief complaint, and abdominal pain is associated with |
| 0:27.3 | critical diagnoses that make up at least probably, you know, or at least could potentially |
| 0:32.0 | make up a quarter of your M4-C-Dem curriculum. |
| 0:36.7 | So it's super high-yield if you want to crush your slow. If you want to be a good |
| 0:40.7 | doctor, you just got to know this stuff. And this week, we're going to start powering through |
| 0:45.3 | this ginormous list of critical diagnoses. And so I'm going to say up front, this is going to, a few |
| 0:52.6 | disclaimers. This is going to miss some |
| 0:54.3 | pediatric stuff. |
| 0:56.0 | Clerkship directors of emergency medicine, they didn't put things like necrotizing |
| 1:00.0 | and teracolitis, malrotation with volvulus, interception. |
| 1:03.5 | That's not on this list. |
| 1:04.9 | And I think they're probably intending that you're learning about that during your |
| 1:08.8 | pediatrics clerkship. |
| 1:10.7 | There are really, so specifically there are 11 critical diagnoses listed in the CDM core |
| 1:16.6 | curriculum. |
| 1:17.5 | And then I'm going to expand on that and add a few big ones that I think you should know |
| 1:21.9 | that kind of fit in well during these episodes for the sake of being thorough because |
| 1:26.5 | they're still maybe not like life-threatening, |
| 1:29.2 | but they're still important and very common. |
... |
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