SCA practice case · Video consultation
“I keep getting cramping pain in my lower left tummy and my bowels are all over the place — the scan mentioned diverticular disease”
Video consultation
Adult patient
Straightforward
Long-term conditions & cancerNew & undifferentiated presentations
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Joan Carver · 62 years · female
Setting
Video consultation — lower abdominal pain with known/suspected diverticular disease
Past history
- Diverticular disease on a previous scan
Medication
- Check repeat record
Allergies
None recorded
Recent notes
Recurrent crampy left lower abdominal pain; alternating constipation and loose stools. Out-of-hours GP, 3 weeks ago: temperature 37.0 °C, pulse 80; abdomen soft, mild left iliac fossa tenderness, no guarding, no mass. CT abdomen 2 years ago (for suspected renal colic): sigmoid diverticulosis; not a test to exclude a colonic tumour. No FIT or colonoscopy on record.
Reason for contact
“Is that what’s causing it, and what do I do about it?”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
DIVERTICULAR DISEASE spans a spectrum that must be distinguished: DIVERTICULOSIS (asymptomatic pouches, often an incidental finding — no treatment needed beyond fibre/lifestyle); symptomatic DIVERTICULAR DISEASE (intermittent left lower-quadrant colicky pain, altered bowel habit, bloating — managed conservatively per NICE NG147 with a high-fibre diet, adequate fluids, lifestyle, management of constipation, bulk-forming laxatives and antispasmodics for pain, paracetamol rather than NSAIDs/opioids, and no antibiotics); and acute DIVERTICULITIS (inflammation — constant LIF pain, fever, localised tenderness/guarding, raised CRP/WCC), where uncomplicated cases in a systemically well person may be managed in primary care with a no-antibiotic strategy (co-amoxiclav if systemically unwell, immunosuppressed or comorbid — NICE NG147) with review, but admission is needed for systemic illness/sepsis, significant pain/peritonism, complications, immunosuppression or inability to cope at home. Recognise and safety-net the COMPLICATIONS/red flags needing urgent admission: severe pain/peritonism, high fever/sepsis, significant PR bleeding/haemorrhage, perforation/abscess, and obstruction (vomiting, distension, absolute constipation). Crucially, do NOT attribute all bowel symptoms to "just diverticular disease", because COLORECTAL CANCER can mimic or coexist — a change in bowel habit is itself a FIT criterion under NICE NG12 and HTG690 (as are an abdominal mass, iron-deficiency anaemia, and age-based rectal bleeding, pain or weight-loss criteria), so offer FIT now and make a suspected cancer pathway referral if FIT is 10 µg Hb/g or more, remembering that a normal FIT does not end the matter if symptoms persist and that an earlier CT reporting diverticula may not have examined the colon for a tumour. The skill is distinguishing diverticulosis/disease/diverticulitis, managing appropriately, safety-netting complications, and not missing colorectal cancer. NICE NG12 lower-GI applies where red flags are present.
The guidance behind it
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