Diverticulitis is basically an inflammation of the diverticula. Usually caused by fecoliths and subsequent decrease in blood flow which results in perforation. Depending on the size of the perf, it can either be a localized infxn or peritonitis. Usually present with LLQ pain, occasional palpable mass, +/- peritoneal signs, fever/leukocytosis. They do not bleed (i.e. no hematochezia) but in some cases the FOBT is +
Diverticulosis manifests as a bleed secondary to erosion. Most likely bleed from the right side, although more diverticula are on the left. The can bleed minimally, but can also bleed to the point of requiring transfusions and even angiography. PE is usually negative. Basically very difficult to diagnose diverticulosis just based on history for other things can lead to similar bleeding (i.e AVMs.)
Ulcerative colitis can also present with blood, usually with a bloody diarrhea associated with tenesmus and crampy abd pain. Usually presenting in younger individuals, as opposed to diverticular disease - which most likely occurs in more aged individuals. UC can present along with extraintestinal manifestations of IBD i.e. E. nodosum, P. gangrenosum, iritis, arthritis, etc.
60yo man w/ h/o constipation now febrile with LLQ pain should ring a bell for diverticulitis.
72yo woman with episode of painless BRPPR with a crit drop of 6 should make you consider diverticulosis.
26yo man w/ a 3wk h/o bloody diarrhea, urgency, and crampy abdominal pain should make you consider IBD as a major cause.
