https://www.amboss.

com/us/knowledge/Gastrointestinal_bleeding
Diverticulosis and colonic diverticular diseases (CDDs)

 Colon carcinoma is the most common source of

lower gastrointestinal blood loss, but the bleeding
Normocytic normochromic anemia (Acute
is often occult (ie, no evidence of visible blood loss
bleeding)
to the patient or clinician).
 Most common cause of severe lower Recheck using Rule of 3 Hematology (ROdaks
gastrointestinal bleeding (LGIB) in adults, book)
accounting for 30–50% of cases of massive rectal
bleeding. Most common cause of brisk
hematochezia (maroon or bright red blood)
 Unlike diverticulitis, which occurs primarily in the
left colon, the right colon is the source of colonic
diverticular bleeding in 50–90% of patients
 A possible explanation for this is that right-sided
diverticula have wider necks and domes, exposing
a greater length of the vasa recta to injury.
 Another contributing factor may be the thinner
wall of the right colon
 most cases of CDH, the bleeding will stop https://books.google.com.ph/books?id=UGVylX6g4i8C&pg
spontaneously (in 75% of patients overall) =PA715&dq=colonic+diverticulitis+can+have+acute+occult
 Pathophysio: As a diverticulum herniates, the +bleeding&hl=en&sa=X&ved=0ahUKEwjYodua3-
boAhUiCqYKHQ2jBxIQ6AEIJzAA#v=onepage&q=colonic%20
penetrating vessel responsible for the wall
diverticulitis%20can%20have%20acute%20occult%20bleedi
weakness at that point becomes draped over the ng&f=false
dome of the diverticulum and is separated from the
bowel lumen only by mucosa. Over time, the vasa
recta are exposed to injury along their luminal
aspect, leading to eccentric intimal thickening and
thinning of the media. These changes may result in
segmental weakness of the artery, predisposing to
rupture into the lumen
https://books.google.com.ph/books?id=UGVylX6g4i8C&pg
=PA715&dq=colonic+diverticulitis+can+have+acute+occult
+bleeding&hl=en&sa=X&ved=0ahUKEwjYodua3-
boAhUiCqYKHQ2jBxIQ6AEIJzAA#v=onepage&q=colonic%20
diverticulitis%20can%20have%20acute%20occult%20bleedi
ng&f=false

FOBT (+):

Rule in UGIT, diverticulitis, colon ca

https://books.google.com.ph/books?id=IoOrDw
AAQBAJ&printsec=frontcover&dq=differentiate+
upper+GI+bleeding+vs+lower+gi+bleeding&hl=e
n&sa=X&ved=0ahUKEwiqxNDFh-
https://gut.bmj.com/content/gutjnl/4/3/273.full
foAhUGCqYKHWp6DUAQ6AEIVzAG#v=onepage
.pdf
&q=diverticulitis&f=false
https://books.google.com.ph/books?id=68Sw_V
EUORAC&pg=PA336&dq=right+colonic+diverticu
litis+can+have+acute+occult+bleeding&hl=en&s
a=X&ved=0ahUKEwjkttCv4-
boAhVhw4sBHVOyAKgQ6AEIPzAD#v=onepage&
q=right%20colonic%20diverticulitis%20can%20h
ave%20acute%20occult%20bleeding&f=false

https://www.sciencedirect.com/sdfe/pdf/downl
oad/eid/1-s2.0-0002961057906165/first-page-
pdf
 Bun/crea ratio :px- 13.1 NORMAL (bet 10:1-20:1)

->Rule in LGIT, R/o UGIt

Increase BUN

Uric ACID: normal

Triglyceride: normal but (+) atherosclerosis

https://books.google.com.ph/books?id=FCbXDdOvB9I
C&pg=PA84&dq=bun+creat+ratio+is+normal+in+lower
+GI+bleeding&hl=en&sa=X&ved=0ahUKEwiagZuHi-
foAhWQdXAKHa85BnQQ6AEINTAB#v=onepage&q=bu
n%20creat%20ratio%20is%20normal%20in%20lower%
20GI%20bleeding&f=false

CEA: borderline

Diverticulitis vs Colon CA
  most endoscopists believe that urgent colonoscopy is not necessary to identify the stigma of bleeding from lower gastrointestinal lesions, such as
diverticula, since the important clinical issue in CDH is that bleeding diverticula are difficult to identify.
 source of bleeding in patients presenting with CDH is diagnosed when the stigma of recent hemorrhage (SRH) is defined as active bleeding from a
diverticulum, a nonbleeding visible vessel, or an adherent clot
 Colonoscopy is a useful procedure for nearly all patients presenting with acute LGIB, because it serves as a diagnostic and potentially therapeutic tool
The advantage of colonoscopy over other diagnostic modalities is its ability to directly visualize lesions, allowing for the exclusion of other etiologies of
LGIB, as well as for immediate therapy. Colonoscopy is safe and effective, with a diagnostic yield of 69–80% in acute LGIB

https://www.karger.com/Article/FullText/490387