Exam 2 ACNP 807- Questions and
Answers
Diverticulitis Overview Correct Ans-Very common
essentially it is just perforations of colonic tissue
micro and macro
Diverticulitis presentation Correct Ans-Diverticulosis(pouches in the colonic wall) is present
in 50 percent of adults over 50 and 10-25% of these pt's will end up with diverticulitis (bulging
pouches in the colonic wall) that become inflamed).....which is just either microperfs or
macroperfs (more serious)
Pt's will typically present with mild to moderate abd pain in the left lower quadrant and
fever....additional symptoms nausea/vomiting ; alternating constipation and diarhhea , dysuria,
hypoactive bs
; when high fever, abd guarding and rebound tenderness occur then think in terms of macroperf
and subsequent perotinitis or free perforation
Diverticulitis labs/diagnostics Correct Ans-Leukocytosis will be present most often however
mild cases white count could be normal
Diagnostic of choice is CT of abdomen to visualize the inflammatory diverticuli.....can check for
severity and make sure perotinitis isn't present.....streaking is common is diverticulitis
, Can order an ESR, CRP to check for inflammation
Diverticulitis Tx Correct Ans-NPO diet.....progress from clear liquids to regular
Dependent on severity but consists of antibiotics, gut rest, supportive treatments, treatment of
complications like an ileus, abscess or perf and in severe cases that don't respond to treatment
surgery
When to consult surgery from diverticulitis Correct Ans-Failure to respond to tx within 72 hrs
Complicaitons such as abscess, ileus, perotinitis
Large abscess may require a percutaneous drain
Recurrent chronic cases may warrant surgical resection
Outpatient treatment diverticulitis Correct Ans-PO antibiotics:
May be limited to supportive tx with clear liquids, progressed to a low fiber diet and then a high
fiber followed.....at risk pt's pregnant, immunocompromised or pt's taking certain meds will need
PO antibiotics if PO antibiotics are used then the choice is Levofloxacin 500mg plus Flagyl 500
mg, 500mg Ciprofloxacin BID plus 500mg of flagyl or Augmentin 500-875mg TID
Inpatient tx diverticulitis Correct Ans-.375g Zosyn q 6
Flagyl plus cipro or Flagyl plus levofloxacin
Immunocompromised with do the penum's......merem 1gq8 or doripenem
Answers
Diverticulitis Overview Correct Ans-Very common
essentially it is just perforations of colonic tissue
micro and macro
Diverticulitis presentation Correct Ans-Diverticulosis(pouches in the colonic wall) is present
in 50 percent of adults over 50 and 10-25% of these pt's will end up with diverticulitis (bulging
pouches in the colonic wall) that become inflamed).....which is just either microperfs or
macroperfs (more serious)
Pt's will typically present with mild to moderate abd pain in the left lower quadrant and
fever....additional symptoms nausea/vomiting ; alternating constipation and diarhhea , dysuria,
hypoactive bs
; when high fever, abd guarding and rebound tenderness occur then think in terms of macroperf
and subsequent perotinitis or free perforation
Diverticulitis labs/diagnostics Correct Ans-Leukocytosis will be present most often however
mild cases white count could be normal
Diagnostic of choice is CT of abdomen to visualize the inflammatory diverticuli.....can check for
severity and make sure perotinitis isn't present.....streaking is common is diverticulitis
, Can order an ESR, CRP to check for inflammation
Diverticulitis Tx Correct Ans-NPO diet.....progress from clear liquids to regular
Dependent on severity but consists of antibiotics, gut rest, supportive treatments, treatment of
complications like an ileus, abscess or perf and in severe cases that don't respond to treatment
surgery
When to consult surgery from diverticulitis Correct Ans-Failure to respond to tx within 72 hrs
Complicaitons such as abscess, ileus, perotinitis
Large abscess may require a percutaneous drain
Recurrent chronic cases may warrant surgical resection
Outpatient treatment diverticulitis Correct Ans-PO antibiotics:
May be limited to supportive tx with clear liquids, progressed to a low fiber diet and then a high
fiber followed.....at risk pt's pregnant, immunocompromised or pt's taking certain meds will need
PO antibiotics if PO antibiotics are used then the choice is Levofloxacin 500mg plus Flagyl 500
mg, 500mg Ciprofloxacin BID plus 500mg of flagyl or Augmentin 500-875mg TID
Inpatient tx diverticulitis Correct Ans-.375g Zosyn q 6
Flagyl plus cipro or Flagyl plus levofloxacin
Immunocompromised with do the penum's......merem 1gq8 or doripenem
