Colonitis Flashcards
Which arteries supply the colon? Which part of the colon do they supply?
SMA - R and middle colic
IMA - left colic, sigmoid, sup. rectal arteries
Iliac arteries - inferior rectal
What are some infectious causes of colitis?
Bacterial - Clostridium difficle
Salmonella
Shigella
Campylobacter
Yersinia
Viral - CMV
Parasitic - Entamoeba
Cryptosporidium
What is the 5 years mortality rate for toxic megacolon requiring surgery?
20%
How do you differentiate colitis from gastroenteritis?
Colitis - bloody diarrhoea
- Older age
- Tenderness
Gastroenteritis - Vomitting
- Young people
- Less leukocytosis
Which part of the colon is most susceptable to low flow ischaemia? Why?
Splenic flexure as it’s an area of watershed
Sigmoid as inferior mesenteric is susceptable to atherosclerosis
When does CMV cause colitis?
In immunosuppressed patients
What are the anatomical types of colitis?
Pancolitis
Segmental
Proctitis
What are some risk factors for ischaemic colitis?
Age
HTN
Diabetes
Smoking
Hypercoagulable state (28% of ischaemic colitis patients)
Cocaine use
Extreme physical activity
Why do you need to test for toxins in C. diff?
Only toxin producing strains cause colitis
(toxins A and B)
What are some causes of colitis?
Infectious
Ischaemic
Inflammatory
Diverticulitis
Radiation induced
What is the pathophysiology of C. diff colitis?
Disruption of normal flora by abx or chemotherapy - eg clindamycin or fluoroquinolones or penicillins
Ingestion of a toxigenic strain of C. difficle
Spores resist the gastric acid and go onto colonise the colon
How does the management of ischaemic colitis differ by location of ischaemia?
Right sided - more likely embolic - need surgery
L sided - more likely low flow - conservative
Why are abx given in ischaemic colitis?
Because bacteria can cross the wall
What is colitis?
Inflammation of the colon
Which part of the colon is more susceptable to an embolic cause of ischaemia?
Caecum as it has a end artery
