Diverticular Disease And Diverticulitis

Question 1

__________________ is an asymptomatic condition characterised by the presence of diverticula (small pouches protruding from the walls of the large intestine)

Answer 1

Diverticulosis

Question 2

Diverticula are defined as…?

Answer 2

Small pouches protruding from the walls of the large intestine

Question 3

The prevalence of diverticulosis is difficult to determine but it is age dependent, with the majority of patients aged _______ years and over.

Answer 3

40

Question 4

______________ is a condition where diverticula are present with symptoms such as abdominal tenderness and/or mild, intermittent lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds.

Answer 4

Diverticular disease

Symptoms of diverticular disease may overlap with other conditions such as Irritable bowel syndrome, colitis (bowel inflammation related to Crohn’s disease, Ulcerative colitis, ischaemia or microscopic colitis), and malignancy.

Question 5

________________ occurs when diverticula suddenly become inflamed or infected.

Answer 5

Acute diverticulitis

Question 6

Acute diverticulitis occurs when diverticula suddenly become ____________ or ____________.

Answer 6

inflamed

infected

Question 7

What are the signs and symptoms of acute diverticulitis? (6)

Answer 7

1. Constant lower abdominal pain (usually severe)
2. Fever
3. Sudden change in bowel habits
4. Significant rectal bleeding
5. Lower abdominal tenderness
6. Palpable abdominal mass

Question 8

What are the symptoms of diverticular disease? (4)

Answer 8

1. Abdominal tenderness
2. Mild, intermittent lower abdominal pain
3. Constipation or diarrhea
4. Occasional large rectal bleeds

Question 9

Symptoms of diverticular disease may overlap with other conditions such as _______________, _______________, and ______________

Answer 9

Irritable bowel syndrome

colitis (bowel inflammation related to Crohn’s disease, Ulcerative colitis, ischemia, or microscopic colitis)

malignancy

Question 10

Complicated acute diverticulitis refers to diverticulitis associated with complications such as _____________, _____________ and ___________, ___________, ______________, ____________, or ___________.

Answer 10

abscess

bowel perforation

peritonitis

fistula

intestinal obstruction

haemorrhage

sepsis

Question 11

___________________ refers to diverticulitis associated with complications such as abscess, bowel perforation and peritonitis, fistula, intestinal obstruction, haemorrhage, or sepsis.

Answer 11

Complicated acute diverticulitis

Question 12

What are the aims of treatment of patients with diverticular disease? (4)

Answer 12

Relieve symptoms
Improve QoL
Manage acute episodes of diverticulitis
Reduce risk of recurrence and complications

Question 13

What lifestyle advice should be given to patients with diverticular disease? (4)

Answer 13

1. Advise to eat a healthy, balanced diet including whole grains, fruits, and vegetables
2. In patients with constipation and on a low fiber diet, a gradual increase in dietary fiber may minimize flatulence and bloating
3. Patients increasing dietary fiber should be advised to drink lots of fluids, especially if dehydration is a risk
4. Advise about the benefits of exercise, weight loss if overweight or obese, and smoking cessation in reducing the risk of symptomatic disease and acute diverticulitis

Question 14

Patients with diverticular disease should also be informed that it may take _______________ for the benefits of increasing fibre in their diet to be achieved and that if a high-fibre diet is tolerated, it should be continued for life

Answer 14

several weeks

Question 15

Patients with diverticular disease should also be informed that it may take several weeks for the benefits of increasing fibre in their diet to be achieved and that if a high-fibre diet is tolerated, it should be continued for __________

Answer 15

life

Question 16

In patients with complicated acute diverticulitis, _________________ management may be required

Answer 16

emergency or elective surgical

Question 17

What is the drug treatment of diverticulosis?

Answer 17

As diverticulosis is an asymptomatic condition, specific treatments are NOT recommended.

Bulk-forming laxatives can be considered for patients with constipation

Question 18

As diverticulosis is an asymptomatic condition, specific treatments are not recommended. __________________ can be considered for patients with constipation

Answer 18

Bulk-forming laxatives

Question 19

________________ are not recommended for patients with diverticular disease

Answer 19

Antibacterials

Question 20

When should bulk-forming laxatives be considered for patients with diverticular disease? (2)

Answer 20

When a high-fiber diet is unsuitable

OR

for patients with persistent constipation or diarrhea

Question 21

Consider the use of ______________ in patients with ongoing abdominal pain, and _____________ in those with abdominal cramps caused by diverticular disease

Answer 21

simple analgesia such as paracetamol

antispasmodics

Question 22

What is the role of NSAIDs and opioid analgesics in the management of diverticular disease?

Answer 22

NOT recommended

Non-steroidal anti-inflammatory drugs and opioid analgesics are not recommended as their use may increase the risk of diverticular perforation

Question 23

Non-steroidal anti-inflammatory drugs and opioid analgesics are not recommended as their use may increase the risk of _______________

Answer 23

diverticular perforation

Question 24

For patients with persistent symptoms of diverticular disease or symptoms that do not respond to treatment, what approach should be taken?

Answer 24

Consider an alternative diagnosis

Question 25

What is the management of patients with acute diverticulitis who are systemically WELL? (3)

Answer 25

1. Offer simple analgesia such as paracetamol
2. Consider watchful waiting and a no-antibacterial prescribing strategy
3. Advise patient to re-present if symptoms persist or worsen
   * Patients with persistent or worsening symptoms should be reassessed in primary care and considered for referral to hospital for further assessment

Question 26

What is the management of patients with acute diverticulitis who have uncontrolled abdominal pain or suspected complications?

Answer 26

Same-day hospital assessment

Question 27

What is the treatment of patients with acute diverticulitis who present with significant rectal bleeding?

Answer 27

Should be referred to hospital urgently

*Treatment with aminosalicylates or prophylactic antibacterials are not recommended to prevent recurrent acute diverticulitis

Question 28

What is the role of aminosalicylates and prophylactic antibacterials in the prevention of recurrent acute diverticulitis?

Answer 28

Their use is NOT recommended