Exam (elaborations)
Gastrointestinal 3 USMLERX BRICKS
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a continuation of the usmle rx bricks notes on gastrointestinal system
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Diverticula of theGastrointestinal Tract
Last Updated: June 7, 2021
access_time12 min
Learning Objectives (4)
After completing this brick, you will be able to:
● Define diverticular disease and explain the difference between
diverticulosis and diverticulitis.
● Describe the gross and microscopic appearance of diverticula and
explain how they are formed.
● Describe the typical clinical course of diverticulosis, including
potential adverse outcomes.
● Briefly describe the management and treatment of diverticular disease.
CASE CONNECTION
RM is a 57-year-old woman who is admitted via the emergency
department for further evaluation of abdominal pain. RM tells you
that her pain is in the left lower quadrant. “I thought it was my
kidney,” she says. “But they tell me the ultrasound is negative. What
else could it be? I had a colonoscopy when I was 50 and it was okay.”
RM is febrile (100.9°F), and there is tenderness to palpation in the left
lower quadrant. Pelvic exam is unremarkable. Her WBC count is
elevated. You order a CT scan of the abdomen.
,What is causing RM’s symptoms and physical examination findings?
What treatment will you recommend? Consider your answers as you
read, and we’ll revisit at the end of the brick.
What Are Diverticula of the
Gastrointestinal Tract?
A diverticulum is a sac-like protrusion of the colonic wall created by
the herniation of the lining mucosa through a defect in the muscular
layer of the gastrointestinal (GI) tract.
Diverticulosis, Diverticulitis, and Diverticular
Disease
Diverticulosis is the presence of diverticula and may be asymptomatic
or symptomatic. Diverticular disease is defined as clinically
significant and symptomatic diverticulosis due to diverticular
bleeding, diverticulitis, segmental colitis associated with diverticula,
or symptomatic uncomplicated diverticular disease.
The diverticula seen in diverticular disease are false diverticula
(pseudodiverticula), meaning only the mucosal and submucosal layers
herniate through the muscular layer of the gut wall. This is in contrast
,to a true diverticulum, in which all layers of the gut wall have
herniated (Figure 1).
Meckel vs Zenker Diverticulum
Meckel diverticulum is a true diverticulum in the terminal ileum of
the small intestine (Figure 2). It is a congenital anomaly due to failure
of the vitelline duct (which connects midgut to yolk sac) to
completely obliterate in utero. The diverticulum is about 2 in long and
is located about 2 ft proximal to the ileocecal valve.
, Figure 2
CREDIT: ©ScholarRx
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