Diverticular disease: Clinical

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Diverticular disease: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 64-year-old woman comes to the emergency department because of cramping left lower quadrant abdominal pain for the past day. She has a past medical history of chronic constipation for which she takes polyethylene glycol. She says that her most recent bowel movement contained a small amount of blood. Her temperature is 38.2°C (100.8°F), pulse is 88/min, respirations are 18/min, and blood pressure is 155/80 mm Hg. Physical examination shows point tenderness at the left lower quadrant with localized guardingWhat is the most likely cause of her symptoms?


Diverticula are small outpouchings that form along the walls of a hollow structure.

In the context of the large intestine, they’re called colonic diverticula, but they can form in the small intestine, as well as other spots like along the esophagus.

Diverticula usually form at weak spots along the wall, like where a blood vessel penetrates the muscle layer of the intestine.

Now there are two types of diverticula. The first is a true diverticula which is a herniation that involves all layers of the intestinal wall - like a Meckel’s diverticulum.

The second is a false or pseudodiverticula which is where only the mucosa and submucosa slide through the intestinal wall, and these end up being more common.

Risk factors for diverticula, including eating a high-fat, red meat diet that’s low in fiber.

Diverticulosis is the presence of diverticula and when there’s colonic diverticula, typically these happen in the left and sigmoid colon- the rectum is usually spared.

Sometimes it’s asymptomatic, and diverticulosis is diagnosed incidentally during an abdominal scan or a colonoscopy that was needed for another reason.

When diverticulosis is symptomatic, it’s called diverticular disease.

Typically diverticular disease causes some abdominal pain and a CT-scan usually shows some bowel thickening. But at this stage, treatment is mainly encouraging a high-fiber diet with grains and vegetables.


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