Bowel Ischemia (ischemic Colitis & mesenteric ischemia) Flashcards
Definition of ischemic colitis
Ischemia of the colonic arterial supply, colon inflamed due to hypo perfusion
Which artery does IC affect?
Inferior mesenteric artery (IMA)
Causes of IC
Thrombosis (+/- atherogenesis) - MC
Emboli
Decreased CO + Arrhythmias (eg. Hx of AF) eg. shock
(+ COCP)
What are the MC sites affected and why?
Watershed areas (most distal)
Splenic flexure (MC)
Sigmoid colon and cecum
Symptoms of IC
LLQ pain and bright bloody stool (+/- signs of hypovolemic shock)
How to diagnose IC?
Colonoscopy + Biopsy - GS
(often after Px fully recovered, prevents stricture formation + normal healing)
Rule out other causes (eg. stool sample - H.Pylori)
Treatment for IC
Symptomatic - IV Fluid + Abx (prophylactic)
Gangrenous - only SURGERY
Complications of IC
Perfusion (therefore SBP)
Strictures (therefore obstruction)
What is mesenteric ischemia?
Ischemia of the small bowel
What are the 2 types of mesenteric ischemia?
Acute and chronic
Chronic mesenteric Ischemia
What is it caused by?
How long does it last?
What does it lead to?
What is it also referred to?
Narrowing of BV due to atherosclerosis
Longer lasting, over months
Leads to intermittent abdo pain
‘Abdo angina’
Symptoms of CMI: TRIAD
Central colick abdo pain after eating (30 mins after for 1-2 hours)
Weight loss - food avoidance
Abdominal bruits - whooshing through BV
Diagnosis of CMI
CT Angiogram
Acute mesenteric Ischemia
What is it caused by?
What is it also referred to?
Acute attack, rapid blockage
Due to thrombus/embolus
‘Abdominal MI’
Sx of AMI: TRIAD
Central/RIF acute severe abdo pain
No abdo signs on exam (eg. guarding, rebound tenderness)
Rapid hypovolemic shock
