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Gastrointestinal Conditions (JBR) > Bowel Ischaemia and Colitis > Flashcards

Bowel Ischaemia and Colitis Flashcards

1
Q

What are the different types of bowel ischaemia?

A

Acute or chronic mesenteric ischaemia

Ischaemica colitis

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2
Q

What causes acute mesenteric ischaemia?

A

Thrombo-embolus (arterial/venous)

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3
Q

What happens when there is a mesenteric thrombo-embolus?

A 
Small bowel dies 
Colon lives (marginal artery)
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4
Q

What is the epidemiology of acute mesenteric ischaemia?

A

> 50

Thrombotic risk factors

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5
Q

What are thrombotic risk factors?

A 
AF
Hx of MI, AAA
Hypotension
Hypercoagulability 
Infection or venous trauma
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6
Q

How does acute mesenteric ischaemia present?

A

Moderate-severe colicky or constant and poorly localised pain out of proportion to physical signs

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7
Q

What are investigations for acute mesenteric ischaemia?

A

FBC, AXR, angiography, CT, ECG

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8
Q

What are treatment options for acute mesenteric ischaemia?

A 
Papaverine
Thrombolytics
Heparin
Angioplasty
Embolectomy
Resect if gangrene develops
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9
Q

What causes chronic mesenteric ischaemia?

A

Atheroscleoris

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10
Q

How does chronic mesenteric ischaemia present?

A

Postprandial pain (moderate-severe colicky or constant poorly localised pain)
Weight loss
Food fear

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11
Q

What are risk factors for chronic mesenteric ischaemia?

A

Smoking
Hypertension
Diabetes
Hyperlipidaemia

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12
Q

What are investigations for chronic mesenteric ischaemia?

A

FBC, LFTs, U+Es, CXXR, arteriography, mesenteric duplex USS

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13
Q

How do you treat chronic mesenteric ischaemia?

A

Surgery (e.g. trans-aortic endarterectomy or bypass)

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14
Q

What is ischaemic colitis?

A

inflammation and injury of the large intestine result from inadequate blood supply

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15
Q

What are causes ischaemic colitis?

A

Thrombus/Embolus
Arrhythmias
Atherosclerosis

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16
Q

Ischaemic colitis typically affects the ___ and ______ arteries

A

middle and left colic

17
Q

Ischaemic colitis is more common in?

A

Elderly

18
Q

How do investigate ischaemic colitis?

A

ABG (metabolic acidosis)
AXR
Colonoscopy
CT colon

19
Q

How do you treat ischaemic colitis?

A

Bowel rest
Conservative management
Abx
Surgery

20
Q

What are complications of bowel ischaemia?

A

Resolution, fibrosis, stricture, chronic ischaemia
Angina of the gut
Obstruction
Gangrene, perforation, peritonitis, sepsis
Death

21
Q

What are the different types of colitis?

A

Antibiotic-induced Pseudomembranous Colitis
Collagenous colitis
Radiation Colitis
Acute (infective colitis)

22
Q

What is the gross appearance of antibiotic-induced pseudomembranous colitis?

A

Patchy yellow membranous exudate on mucous surface

23
Q

What is the microscopic appearance of antibiotic-induced pseudomembranous colitis?

A

Explosive fibropurulent exudate on surface

Explosive lesions of mucosa

24
Q

What causes antibiotic-induced pseudomembranous colitis?

A

C. diff (patients on broad-spectrum antibiotics)

25
Q

What is the mechanism of action by which C. diff causes colitis?

A

Toxin A and B attack endothelium and epithelium

26
Q

What are features of antibiotic-induced pseudomembranous colitis presentation?

A

Massive bleeding and diarrhoea

27
Q

How do you treat Antibiotic-induced pseudomembranous colitis?

A

Metronidazole / Vancomycin

may need colectomy - can be fatal

28
Q

What are macroscopic features of collagenous colitis?

A

Thickened basement membrane (normal 2-3 um)

patchy

29
Q

What are microscopic features of collagenous colitis

A

Associated with intra-epithelial inflammatory cells
No chronic architectural changes
Loss of barrier function

30
Q

Collagenous colitis causes loss of barrier function leading to?

A

Watery diarrhea

31
Q

What is radiation colitis?

A

Chronic, inactive colitis caused by radiation therapy

32
Q

Radiation colitis may be a complication of?

A

Immunosuppression

33
Q

What are microscopic features of radiation colitis?

A

Telangiectasia

34
Q

What is telangiectasia?

A

Widened blood vessels

35
Q

What is found on histopathology for acute (infective) colitis?

A

Busy epithelium but no crypt irregularity

Focal acute cryptitis in otherwise unremarkable colonic mucosa

Gastrointestinal Conditions (JBR) (33 decks)

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