Diverticular Disease

Answer Explanation:

• The correct answer is ‘Bed rest is usually sufficient to control haemorrhage’. This is because in most cases of diverticulosis, bleeding stops by itself and can be managed conservatively with bed rest and monitoring. It is only in severe cases where the bleeding does not stop or the patient becomes haemodynamically unstable that more invasive interventions may be required.

Incorrect Options Explanation:

• ‘Haemorrhage is usually associated with severe colicky pain’ is incorrect. Diverticular bleeding is usually painless and presents with sudden, bright red or maroon coloured rectal bleeding.
• ‘Intravenous antibiotics have no role in acute diverticulitis’ is incorrect. Antibiotics are indeed a mainstay of treatment in acute diverticulitis, often given intravenously, especially in severe cases or those with complications.
• ‘Diverticular abscesses are caused by Salmonella typhi’ is incorrect. Diverticular abscesses are usually caused by normal colonic flora, not Salmonella typhi.
• ‘Perforation is not a risk’ is incorrect. Perforation is a serious complication of diverticulitis and can lead to peritonitis, sepsis and even death.

Overview of Diverticulosis:

• Definition: Diverticulosis refers to the presence of diverticula, small pouches that can form in the wall of the colon, without associated inflammation or symptoms.
• Symptoms: Most people with diverticulosis have no symptoms. When symptoms do occur, they may include mild cramps, bloating and constipation.
• Complications: Complications of diverticulosis include diverticulitis (inflammation of the diverticula), formation of abscesses, perforation, bleeding, and rarely, fistula formation.
• Management: Management of diverticulosis includes a high-fibre diet to prevent constipation and reduce the risk of diverticulitis. In the event of complications such as diverticulitis or bleeding, treatment may involve antibiotics, bed rest, or in severe cases, surgery.

Answer Explanation:

• The correct answer is “Diet is implicated in the aetiology”. This is because a diet low in fiber has been linked to the development of diverticular disease. A low-fiber diet can lead to constipation, which can cause increased pressure in the colon, leading to the formation of diverticula.

Incorrect Options Explanation:

• The caecum is not the most commonly affected part of the colon in diverticular disease. The sigmoid colon is most commonly affected.
• Right iliac fossa pain is not the commonest symptom of diverticular disease. The most common symptom is actually left lower quadrant pain.
• Antispasmodic drugs are not contraindicated in diverticular disease. They are often used to help manage symptoms of diverticular disease such as abdominal pain and cramping.
• Young people are not most affected by diverticular disease. The prevalence of diverticular disease increases with age, with the majority of cases occurring in individuals over the age of 60.

Overview of Diverticular Disease:

• Definition: Diverticular disease refers to the presence of diverticula (small pouches) in the colon that bulge outward through weak spots in the colon wall.
• Cause: The exact cause of diverticular disease is unknown, but it is thought to be related to age, diet, and lifestyle factors. A diet low in fiber is particularly implicated.
• Symptoms: Many people with diverticular disease have no symptoms. When symptoms do occur, they may include abdominal pain (usually in the left lower quadrant), bloating, constipation or diarrhea, and occasionally, bleeding.
• Treatment: Treatment for diverticular disease focuses on relieving symptoms, preventing complications, and reducing the risk of future diverticula. This may include a high-fiber diet, exercise, and medications to manage pain and inflammation. In severe cases, surgery may be required.