Gen Surg: ischaemic colitis and mesenteric ischaemia

Question 1

What does ischaemic colitis usually present with?

Answer 1

Acute rectal bleeding due to tissue necrosis.

Question 2

How does mesenteric ischaemia present?

Answer 2

• Sudden serve abdo pain out of proportion with clinical exam.
• N&V,
• signs of shock,
• PR bleed seen in advanced ischaemia
• metabolic acidosis on ABG,

Question 4

What is the triad of Acute mesenteric ischaemia?

Answer 4

• severe abdominal pain,
• unremarkable abdo exam
• shock

Question 5

How does ischaemic colitis present?

Answer 5

• Generalised abdo pain +++, not explained by findings;
• Bloody diarrhoea
• diffuse and constant in nature.
• Nausea and vomiting.

Question 6

What is found on examination of pt with ischaemic colitis?

Answer 6

• Non-specific tenderness.
• If perforated - signs of peritoneum - tachycardia, low bp, guarding, laying v still.

Question 7

How is ischaemic colitis managed (definitive)?

Answer 7

• Anticoagulation may be needed if cause was thromboembolic
• Usually supportive management which resolves on its own
• Surgical treatment rarely needed- if necrosis, uncontrollable bleeding or perforation
• Excision of necrotic bowel if unable to revascularise. Revascularisation of the bowel.

Question 8

What are differentials of ischaemic colitis?

Answer 8

• Peptic ulcer disease,
• bowel perforation,
• Symptomatic AAA.

Question 9

What is ischaemic colitis?

Answer 9

• acute but transient compromise in the blood flow to the large bowel.
• This may lead to inflammation, ulceration and haemorrhage.

Question 10

Where is ischaemic colitis most likley to occur?

Answer 10

• more likely to occur in ‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

Question 11

Inv for ischaemic colitis?

Answer 11

• Xray- thumbprinting

Question 12

Complications of ischaemic colitis?

Answer 12

• Ischaemic stricture
• Bowel necrosis

Question 13

What is acute mesenteric ischaemia?

Answer 13

• caused by an embolism resulting in occlusion of an artery which supplies the small bowel, for example the superior mesenteric artery.
• Classically patients have a history of atrial fibrillation.

Question 14

What is usually in the hx of a pt with acute mesenteric ischaemia?

Answer 14

• AF

Question 15

Management of acute mesenteric ischaemia?

Answer 15

• immediate laparotomy is usually required, particularly if signs of advanced ischemia e.g. peritonitis or sepsis
• poor prognosis, especially if surgery delayed