Diverticular Bleeding

1. See Also
   1. Diverticulosis
   2. Lower Gastrointestinal Bleeding
2. Epidemiology
   1. Most common cause of Lower Gastrointestinal Bleeding
   2. Severe, life threatening Lower Gastrointestinal Bleeding occur in 3% of patients with Diverticulosis
3. Risk Factors
   1. Age over 65 years
   2. Increased risk with NSAIDs or Aspirin
4. Pathophysiology
   1. Diverticula can occur anywhere in the Large Bowel
   2. Most common site for Diverticular Bleeding is at on ther right side, at the ascending colon (thinner wall)
5. Symptoms
   1. Painless rectal hemorrhage
   2. Irritate symptoms due to acute bleeding may occur
      1. Mild abdominal cramping
      2. Stool urgency
6. Signs
   1. Red to maroon stool which may contain intermixed blood clot
7. Differential Diagnosis
   1. See Lower Gastrointestinal Bleeding
   2. Signs of Hemorrhagic Shock may be present
      1. Tachycardia
      2. Hypotension
      3. Orthostatic Hypotension
8. Course
   1. Bleeding spontaneously ceases in 75%, recurs in 38%
   2. Recurrence is 9% at one year and 25% at 4 years
9. Prognosis: Comorbidities that increase complication risk
   1. Hypertension
   2. Diabetes Mellitus
   3. Chronic Obstructive Pulmonary Disease (COPD)
   4. Chronic Kidney Disease
   5. Coronary Artery Disease
10. Prevention
    1. Avoid Aspirin and NSAIDs
    2. Increase Dietary Fiber
    3. Weight loss in Obesity with goal Body Mass Index <30 kg/m2
11. References
    1. Wilkins (2009) Am Fam Physician 80(9): 977-83