Quiz Questions:
1. All of the following are associated with diverticular disease except?
A. Age greater than 60 years
B. Increased intracolonic pressure
C. Abnormal neuromuscular formation and alterations in intestinal motility
D. H. Pylori infection
E. Decreased dietary fiber
2. Diverticulosis is the presence of inflamed diverticula, true or false?
A. True
B. False
3. Diverticula are best described as:
A. Associated with the nucleotide binding oligomerization domains gene mutation
B. Saclike outpouchings of the mucosa through the muscle layers of the colon wall
C. A break in the mucosal lining of the esophagus, stomach, or duodenum
D. A gastrin secreting neuroendocrine tumor or multiple tumors
4. Your patient has a history of diverticular disease and presents with a fever, elevated white blood cell count and complains of tenderness in his left lower quadrant. You are concerned an abscess may have formed from inflamed diverticula. What diagnostic test should be performed?
A. Endoscopy
B. Colonoscopy
C. Abdominal CT scan
D. Rectal exam
5. A high fiber diet relieves symptoms of diverticular disease by doing all of the following except?
A. Decreases fecal transit time
B. Increases fecal motility
C. Reduces intracolonic pressure
D. Help remove diverticula from the intestinal wall
Rationale and answers to quiz questions:
1. Answer: letter D or H. Pylori infection
Rationale: H. Pylori is can lead to many gastrointestinal problems such as gastritis and peptic ulcer disease but is not a factor in diverticula formation. Diverticula form in weak areas in the colon wall. Although there is not a definite cause of diverticulosis age greater than 60, decreased dietary fiber, increased intracolonic pressure, and abnormal neuromuscular formation and alterations in intestinal motility are associated with the disease.
2. Answer: letter B, false
Rationale: Diverticulosis is the presence of diverticula but they are not inflamed. Diverticulitis is when diverticula become inflamed.
3. Answer: letter B
Rationale: saclike outpouching in the abdominal wall best describes diverticula. Nucleotide binding oligomerization domains gene mutation best describes the gene associated with Crohn disease. A break in the mucosal lining of the esophagus, stomach, or duodenum best describes peptic ulcer. A gastrin secreting neuroendocrine tumor or multiple tumors best describe gastrinoma in Zollinger-Ellison syndrome.
4. Answer: letter C
Rationale: Since the patient has a fever, leukocytosis and possible abscess the best diagnostic test would be a CT scan. An abscess can be identified without further disruption of the intestinal wall. Diverticula are generally found in the left colon so an endoscopy would less helpful. A colonoscopy could be used but would be more invasive and could cause more harm to the patient’s intestinal wall and well as a rectal exam.
5. Answer: letter D
Rationale: Decrease fecal transit time, increase fecal motility, and reduces intracolonic pressure are all helpful aspects of a high fiber diet. Diverticula should not be removed from the intestinal wall as uncontrolled bleeding could occur.