Chapter 115: Diverticular Disease Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient with a history of diverticular disease asks what can be done to minimize acute symptoms. What will the provider recommend to this patient?

a. Avoiding saturated fats and red meat b. Consuming a diet high in fiber c. Taking an anticholinergic medication d. Using bran to replace high-fiber foods

ANS: B a. Ordering a CBC and stool for occult blood b. Prescribing an antispasmodic medication c. Referring the patient for a lower endoscopy d. Reminding the patient to eat a high-fiber diet

Increasing dietary fiber reduces constipation and reduces the incidence of acute symptoms. Avoiding saturated fats and red meats does not reduce the risk of diverticulitis but does decrease the risk of colon cancer. Anticholinergics and antispasmodics do not prevent attacks but may help with symptoms. Bran may be used as an adjunct to high-fiber foods but should not replace other high-fiber sources.

2. A patient with a history of diverticular disease experiences left-sided pain and reports seeing blood in the stool. What is an important intervention for these symptoms?

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ANS: C

Patients with suspected diverticular abscess of rectal bleeding need further evaluation and a referral for lower endoscopy is warranted. Hemorrhage is more common from the right colon. The other actions do not have priority over the need to evaluate the cause of the bleeding.

Multiple Response

1. A patient has intermittent left-sided lower abdominal pain and fever associated with bloating and constipation alternating with diarrhea. The provider suspects acute diverticulitis. Which tests will the provider order? (Select all that apply.)

a. Barium enema examination b. Computerized tomography (CT) scan of abdomen and pelvis c. Plain abdominal radiographs d. Rigid sigmoidoscopy e. Stool for occult blood

ANS: B, E

For symptomatic diverticulosis, the diagnosis of diverticulosis or segmental colitis (as with SCAD) can be established by direct view on colonoscopy or flexible sigmoidoscopy. A CT scan of the abdomen can also diagnose diverticulosis. A barium or water-soluble enema should not be utilized if acute diverticulitis is suspected. Plain abdominal x-ray films will be normal and are unnecessary, although they are sometimes ordered to exclude the presence of free air in the abdomen.