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General Surgery > Colonic Ischaemia > Flashcards

Colonic Ischaemia Flashcards

1
Q

What is colonic ischaemia?

A
  • Insufficient blood supply to large bowel
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2
Q

What is the nature of colonic ischaemia?

A
  • most commonly non-occlusive
  • spontaneously resolve
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3
Q

What is the most common form of intestinal ischaemia?

A
  • colonic ischaemia
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4
Q

What are the types of intestinal ischaemia?

A
  • Colonic (large bowel)
  • Mesenteric (small bowel)
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5
Q

What are the two main blood supplies to the colon?

A
  • SMA
  • IMA
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6
Q

Where does the SMA arise?

A
  • From AA at L1
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7
Q

What are the branches of the SMA? What do these branches supply?

A
  • Ileocolic artery - transverse colon
  • R colic artery - ascending colon
  • M colic artery - transverse colon
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8
Q

What are the branches of the IMA? What do these branches supply?

A
  • L colic artery
    • descending colon
  • Sigmoid artery
    • distal dc and sigmoid
  • Sup rectal artery
    • upper 2/3 of rectum
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9
Q

What is the Marginal artery of Drummond?

A
  • SMA and IMA forms f the marginal artery of Drummond
  • a vessel that runs along the inner margin of the colon providing branches to the bowel wall
  • It receives contributions from the ileocolic, right, middle and left colic arteries
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10
Q

What are the causes of CI?

*think non occlusive and occlusive

A

Non-occlusive (reduced perfusion to colon)

  • Heart failure
  • Septic shock
  • Vasopressors (e.g. noradrenaline, cause vasoconstriction)
  • Recent CABG
  • Renal impairment
  • Peripheral vascular disease
  • Cocaine use

Occlusive

  • Mesenteric arterial embolism
  • Mesenteric arterial thrombosis
  • Venous thrombosis
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11
Q

What are the cf of CI?

A
  • Abdominal pain
  • Bloody Diarrhoea
  • Haematochezia
  • Fever
  • Tenderness
  • Peritonism
  • Pyrexia
  • Tachycardia
  • Haemodynamic instability
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12
Q

What Ix would you order for CI?

A

Bedside

  • Observations
  • Blood sugar

Blood test

  • FBC
  • Renal function
  • LFTs
  • CRP
  • Clotting screen
  • Group and save
  • Venous/arterial blood gas (includes a lactate)

Imaging

  • CT c arterial phase contrast

Special test

  • Colonoscopy / flex sig
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13
Q

How would you generally mx CI?

A
  • Supportive care
  • Non occlusive
  • Occlusive
  • Surgical
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14
Q

What supportive care can be provided to CI?

A
  • NBM
  • NG tube
  • IVF resus
  • UC & UO
  • Broad spec abx - if perforatinon
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15
Q

How would you mx non occlusive pathology?

A
  • Self limiting
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16
Q

How would you mx occlusive pathology?

A
  • UFH
  • LMWH
  • Embolectomy
  • Catheter directed thrombolysis
  • Mesenteric angioplasty
17
Q

What are the surgical options for CI?

A
  • Surgical exploration
  • Laparoscopic resection

General Surgery (20 decks)

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