Q&A Medicine>>>>>Gastroenterology
Question 46#

A 52-year-old woman presents for her annual physical examination. Her past medical history is significant for hypertension and diabetes mellitus type 2. She endorses smoking two packs of cigarettes per day for the past 18 years. Her vital signs are stable and her physical examination is unremarkable. She receives a colonoscopy that demonstrates multiple diverticular outpouchings. The patient is very concerned and has plenty of questions about the conditions.

Which of the following recommendations should be offered to this patient in the setting of her newly diagnosed condition?

a. Smoking cessation
b. Prophylactic broad-spectrum antibiotics
c. Elective surgical resection
d. Increase daily fiber intake

Correct Answer is D

Comment:

Increase daily fiber intake. This patient has multiple diverticula on colonoscopy. Her diverticulosis is currently asymptomatic, but symptomatic diverticulosis can present with abdominal pain, constipation, and painless rectal bleeding. The only recommendation at this stage of the patient’s diverticular disease is dietary modification, specifically to increase her daily fiber intake. This generates bulky stools that decrease the likelihood of developing more diverticula. (A) Smoking cessation should always be recommended to any patient. However, research has not shown that this improves diverticulosis. (B) Antibiotics are the treatment of choice in diverticulitis that is uncomplicated; however, diverticulitis is associated with fever and leukocytosis, neither of which this patient has. (C) Surgery is recommended in complications of diverticular disease, including bleeding or perforation. This patient has asymptomatic diverticulosis and should not be offered surgery.