GASTROENTEROLOGY LITERATURE REVIEW SESSION

MARCH 30, 2000

 Stollman NH, Raskin JB.  Diagnosis and management of diverticular disease of the colon in adults.  Am J Gastroenterol 1000;94:3110-3121.

 1.  Regarding recurrence of acute diverticulitis

a.      It occurs in 25% to 30% of patients

b.      Recurrent episodes are less likely to respond to therapy

c.      Elective resection is recommended after 2 attacks of uncomplicated diverticulitis

d.      Risk of recurrence may be higher in patients younger than age 50 at the time of the initial attack

2.  Clinical features consistent with diverticulitis include

a.      severe rectal bleeding

b.      fever

c.      leukocytosis

d.      thrombocytopenia

e.      left lower quadrant tenderness with or without rebound

f.        urinary frequency and dysuria

g.      painful rectal exam

3.  Antibiotics recommended for the inpatient treatment of acute diverticulitis include

a.      metronidazole + clindamycin

b.      gentamycin + metronidazole

c.      ceftriaxone alone

d.      ceftriaxone + metronidazole

e.      cefotetan alone

f.        ticarcillin clavulanate alone

4.  Regarding fistulous complications from diverticulitis

a.      colovesical fistulae are the most common

b.      colovesical fistulae are more common in females

c.      colovaginal fistulae are the second most common type of fistula

d.      Barium enema is helpful in diagnosing a colovesical fistula

5.  Diet for symptomatic diverticular disease

a.      Exclusion of nuts, corn and seeds is essential

b.      High fiber diet will result in regression of the diverticuli with time

c.      A fiber intake of at least 30-35 grams is recommended, patients should increase the fiber intake to 50g initially and then reduce to a maintenance dose of 30-35 grams

d.      Most studies have shown symptomatic improvement with fiber supplementation.

e.      The use of anticholinergic medications is not supported by randomized clinical trials.

True of False

 6.  All patient with suspected diverticulitis should undergo erect and supine abdominal radiographs.

 7.  Dysuria and urinary frequency in a patient with diverticulitis signal the occurrence of a sigmoid-vesical fistula with urinary tract infection.

 8.  Diverticulitis is the most common clinical complications of diverticulosis and affects 10-25% of patients with colonic diverticuli.

 9.  Colonic resection should be considered after the first attack of diverticulitis in an immunocompromised patient.

 10.  Severe hemorrhage complicates 15% to 20% of patients with diverticulosis

 11.  Fifteen to 30% of patients admitted with acute diverticulitis will require surgery during the hospitalization.

 12.  Prevalence of diverticulosis in the elderly is 50% to 66%, clinical illness related to diverticuli is manifested in 20%.

 13.  In most studies, CT scan has a >90% sensitivity for the diagnosis of acute diverticulitis, it should be obtained in all patients suspected of having acute diverticulitis.

 14.  The thickened mucosal wall seen in patients with diverticulosis is due to smooth muscle hypertrophy.

 15.  The presence of diverticulosis is a common cause for positive fecal occult blood test or iron deficiency anemia.

 16.  Asian patients with diverticulitis are more likely to present with right lower quadrant pain from diverticulitis than Americans.

 17.  The development of intestinal obstruction during acute diverticulitis is an absolute indication for surgery

 18.  An 65 year old patient with left lower quadrant intermittent discomfort, no fever or leukocytosis, mild LLQ tenderness on palpation, altered bowel habits and a barium enema showing only sigmoid diverticulosis requires no further evaluation.

 19.  Flexible sigmoidoscopy and colonoscopy are extremely useful in the initial evaluation of patients with suspected acute diverticulitis.

 20.  Antibiotics recommended for the outpatient treatment of diverticulitis include

a.      tetracycline

b.      clarythromycin

c.      sufamithoxazole-trimethoprim with metronidazole

d.      quinolones with metronidazole

e.      amoxicillin plus clavulanic acid

 21.  Improvement in the patient’s condition after initiation of antibiotics is expected in

a.      24 to 26 hours

b.      2 to 3 days

c.      5 to 7 days

d.      7 to 10 days

 22.  Management of diverticular abscess

a.      small pericolic abscess can be treated with antibiotics

b.      for distant abscess or unresolving pericolic abscess, CT drainage should be considered.

c.      CT drainage is the preferred approach for multiloculated complex abscesses

d.      Once the abscess is drained percutaneously, surgery is rarely needed.

 23.  Diverticular bleed

a.      The risk is 3%-5% among patients with diverticulosis

b.       Bleeding is painless

c.      Often occurs in association with diverticulitis

d.      Stops in 70-80% of patients spontaneously

e.      Rebleeding rates after first episode is 22% to 38%

f.        Rebleeding after second episode is 50%

g.      Colectomy should be considered after the first bleeding episode.

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