Diverticular Disease – Top USMLE Diseases

Gastrointestinal bleeding indicates underlying pathology in either the upper or lower gastrointestinal (GI) tract. Hematemesis (vomiting red blood or “coffee-ground” material) and melena (black, tarry stool) usually indicate upper GI bleeding proximal to the suspensory ligament of the duodenum, also called the ligament of Treitz. Peptic ulcer disease (PUD) is the most common cause of upper GI bleeding. Hematochezia (red blood in the stool) is most often associated with lower GI bleeding (although it infrequently occurs with massive upper GI bleeding that is typically associated with hypotension). Lower GI bleeding can be from diverticular disease, angiodysplasia, polyps or tumors, inflammatory bowel disease, or internal hemorrhoids. Diagnosis is made by clinical history and physical exam, followed by upper and/or lower GI endoscopy. The source of the bleeding can usually be identified and treated with endoscopy.

Diverticula are protrusions of the bowel wall occurring most commonly in the colon. The condition of having diverticula (called diverticulosis) is mostly asymptomatic. These diverticula can become symptomatic, however, when associated with diseases. Diverticulitis is the inflammation of diverticula, often presenting with lower abdominal pain and changes in bowel habits. The condition may be further complicated by abscess, perforation, fistula, and bowel obstruction. Management consists of antibiotics, fluid resuscitation, and bowel rest. Surgery is required for complications, failure of medical management, and recurrent disease. In most cases of diverticular bleeding, spontaneous cessation occurs. Invasive intervention will be needed for persistent or recurrent bleeding.

Gastrointestinal bleeding (GIB) is a symptom of multiple diseases within the gastrointestinal (GI) tract. Gastrointestinal bleeding is designated as upper or lower based on the etiology’s location to the ligament of Treitz. It is more common to have bleeding in the upper GI tract, with peptic ulcer disease being the most frequent cause. Depending on the location of the bleeding, the patient may present with hematemesis (vomiting blood), melena (black, tarry stool), or hematochezia (fresh blood in stools). Some patients presenting with GIB can be hemodynamically unstable and require emergent stabilization and evaluation. The source of the bleed can often be located and treated with endoscopy.