Ischaemic Colitis Flashcards
What is ischaemic colitis?
acute but transient compromise in the blood flow to the large bowel
What can ischaemic colitis lead to?
Inflammation, ulceration and haemorrhage
Where is ischaemic colitis more likely to occur?
‘watershed’ areas such as the splenic flexure
How is ischaemic colitis diagnosed?
abdominal x-ray
What might you see on an abdominal x-ray of someone with ischaemic colitis?
‘Thumbprinting’ due to mucosal oedema/haemorrhage
What is the management of ischaemic colitis?
- usually supportive
- surgery may be required in a minority of cases if conservative measures fail
When might surgery be indicated for ischaemic colitis?
Generalised peritonitis
Perforation
Ongoing haemorrhage
What are the common features of bowel ischaemia?
abdominal pain
rectal bleeding
diarrhoea
fever
How does abdominal pain present in someone with acute mesenteric ischaemia?
Sudden onset, severe and out-of-keeping with physical exam findings
What do the bloods of someone with bowel ischaemia show?
Elevated white blood cell count associated with a lactic acidosis
How is bowel ischaemia usually diagnosed?
CT
What is acute mesenteric ischaemia usually caused by?
Embolism resulting in occlusion of an artery which supplies the small bowel
Which artery is usually occluded resulting in acute mesenteric ischaemia?
Superior mesenteric artery
What do patients with acute mesenteric ischaemia usually have a history of?
Atrial fibrillation
How is acute mesenteric ischaemia usually managed?
urgent surgery- poor prognosis, especially if surgery delayed
What is ischaemia in the lower GI tract broken into?
acute mesenteric ischaemia
chronic mesenteric ischaemia
ischaemic colitis
What are the main presenting features of acute mesenteric ishcaemia?
Sudden onset severe umbilical pain
Vomiting
Bloody diarrhoea
Pain out of proportion to clinical finding
What would you look for in a VBG of someone with acut emesenteric ischaemia?
Raised lactate
Metabolic acidosis
What other investigation can be done for bowel ischaemia?
CT angiography abdomen and pelvis with contrast
