Diverticulitis Quiz

Diverticulitis: Practice Guide for Exam-Style Questions

Understanding Diverticulosis vs. Diverticulitis

A frequent exam question hinges on distinguishing these two terms. Remember the suffixes: “-osis” means a condition of, while “-itis” means inflammation. Diverticulosis is simply the presence of asymptomatic pouches (diverticula) in the colon wall. Diverticulitis is the clinical illness that occurs when these pouches become inflamed or infected.

Key Risk Factors and Pathophysiology

Low dietary fiber is the cornerstone risk factor. Lack of fiber leads to harder stool and increased intraluminal pressure in the colon, causing herniation of the mucosa through weak points in the muscle wall. Other major risk factors include advanced age, obesity, smoking, and a sedentary lifestyle.

Classic Clinical Presentation

For multiple-choice questions, look for the classic triad: constant, sharp pain in the left lower quadrant (LLQ), fever, and leukocytosis (elevated white blood cell count). The pain location is key, as the sigmoid colon is the most commonly affected segment.

• Steady, severe abdominal pain, typically in the LLQ
• Fever and chills
• Nausea and vomiting
• Change in bowel habits (constipation or diarrhea)
• Tenderness upon palpation of the lower abdomen
• Bloating and gas

Diagnostic Imaging: Choosing the Right Test

The gold standard for diagnosing acute diverticulitis is a CT scan of the abdomen and pelvis with contrast. It can confirm inflammation and, crucially, identify complications like abscesses, fistulas, or perforation. Colonoscopy is contraindicated during an acute attack due to the risk of perforation.

Hinchey Classification for Complicated Cases

Understanding the Hinchey classification helps in questions about management. Stage I involves a small, confined pericolic abscess. Stage II is a larger, retroperitoneal or pelvic abscess. Stage III indicates purulent peritonitis (ruptured abscess), and Stage IV signifies fecal peritonitis (free perforation).

Management of Uncomplicated Diverticulitis

Outpatient management is appropriate for most mild cases. The standard approach includes bowel rest (clear liquid diet) and oral antibiotics targeting gram-negative rods and anaerobes (e.g., ciprofloxacin plus metronidazole). Recent guidelines suggest that antibiotics may be omitted in select, very mild cases.

Treating Complicated Diverticulitis

Complicated cases (Hinchey Stage I or higher) require hospitalization. Treatment includes IV antibiotics, bowel rest, and potentially percutaneous drainage of any abscess larger than 3-4 cm. Surgical intervention, like a Hartmann’s procedure, may be necessary for perforation, large undrainable abscesses, or clinical deterioration.

Long-Term Management and Prevention Strategies

After an episode resolves, the focus shifts to prevention. The single most important recommendation is a high-fiber diet. The goal is to keep stool soft and reduce intracolonic pressure, preventing future flare-ups.

• Whole grains (oats, brown rice, quinoa)
• Legumes (lentils, beans, chickpeas)
• Fruits (berries, apples with skin, pears)
• Vegetables (broccoli, carrots, leafy greens)
• Nuts and seeds (once inflammation has fully resolved)

Key Takeaways

• Diverticulosis vs. Diverticulitis: Presence of pouches vs. inflammation of pouches.
• Classic Symptom: Left Lower Quadrant (LLQ) pain is the hallmark.
• Top Risk Factor: A low-fiber diet is the primary modifiable risk factor.
• Go-To Diagnosis: Abdominal/pelvic CT scan is the diagnostic test of choice.
• Prevention: A high-fiber diet is key to long-term management.

This guide provides a focused overview of diverticulitis for educational and informational purposes. It covers the essential distinctions between diverticulosis and diverticulitis, key diagnostic criteria, modern treatment approaches for both uncomplicated and complicated cases, and essential prevention strategies centered on dietary fiber.