Diverticulitis and Diverticulosis vs Acute Appendicitis
Diverticulitis and Diverticulosis and Acute Appendicitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Diverticulitis and Diverticulosis vs Acute Appendicitis at a glance
- Diverticulitis and Diverticulosis: Acquired colonic outpouchings; inflammation produces left lower quadrant pain and fever.
- Acute Appendicitis: Obstruction-driven inflammation of the appendix; classic periumbilical-to-RLQ pain with peritoneal signs.
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Side-by-side comparison
| Feature | Diverticulitis and Diverticulosis | Acute Appendicitis |
|---|---|---|
| At a glance | Acquired colonic outpouchings; inflammation produces left lower quadrant pain and fever. | Obstruction-driven inflammation of the appendix; classic periumbilical-to-RLQ pain with peritoneal signs. |
| Classic presentation | Older adult with LLQ pain, fever, and leukocytosis — 'left-sided appendicitis.'; Diverticulosis: usually asymptomatic; incidental on colonoscopy or imaging; Diverticular bleed: painless, brisk hematochezia (most common cause of LGIB); Diverticulitis: left lower quadrant pain (sigmoid), constant, often worsening over 1-3 days; Fever,… | Periumbilical pain → migration to RLQ + anorexia + nausea + low-grade fever + RLQ tenderness with peritoneal signs.; Periumbilical pain migrating to RLQ over 12-24 h (visceral → somatic); Anorexia (highly sensitive); Nausea and vomiting (after onset of pain — unlike gastroenteritis where vomiting precedes pain); Low-grade fever;… |
| Workup / key labs | CT-confirmed pericolonic inflammation with diverticula. Modified Hinchey classification: Ia (pericolic phlegmon), Ib (pericolic abscess <4 cm), II (pelvic/intra-abdominal abscess), III (purulent peritonitis), IV (feculent peritonitis).; CBC (leukocytosis with left shift); BMP, lactate (if severe); CRP — predicts severity; Urinalysis… | Clinical diagnosis supported by imaging. Histopathology confirms post-operatively.; CBC — mild to moderate leukocytosis (10-18,000) with left shift; very high WBC suggests perforation; BMP, CRP; Urinalysis — exclude UTI; mild pyuria/hematuria possible from inflamed appendix adjacent to ureter; Pregnancy test in women of childbearing age… |
| Imaging | CT abdomen/pelvis with IV contrast — MODALITY OF CHOICE; identifies pericolic inflammation, bowel wall thickening, abscess, fistula, free air; classifies by Hinchey stage; AVOID colonoscopy during acute diverticulitis (perforation risk); perform 6-8 weeks AFTER resolution to exclude malignancy when first episode or alarm features;… | CT abdomen/pelvis with contrast — modality of choice in adults; sensitivity and specificity >95%; findings: dilated appendix >6 mm, wall thickening, periappendiceal fat stranding, fluid, abscess, fecalith; Ultrasound — first-line in children and pregnant women to avoid radiation; operator-dependent; MRI — alternative in pregnancy if… |
| First-line treatment | Uncomplicated diverticulitis (Hinchey Ia, mild Ib without significant abscess): often managed as outpatient; bowel rest as tolerated; antibiotics selective rather than universal per AGA 2015 (consider in elderly, immunocompromised, comorbidities, severe symptoms); Outpatient antibiotic regimens: amoxicillin-clavulanate, or… | NPO, IV fluids, analgesia, antiemetics; IV antibiotics covering Gram-negative and anaerobic flora — piperacillin-tazobactam, ceftriaxone + metronidazole, or ertapenem; administer pre-operatively; Laparoscopic appendectomy — standard of care; lower wound infection rate and faster recovery vs open; Open appendectomy — alternative when… |
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