Ischaemic Colitis

Question 1

Describe the difference between Mesenteric Ischaemia and Ischaemic Colitis

Answer 1

Mesenteric:
- small bowel
- usually embolism
- severe symptoms, sudden onset
- need surgery
- high mortality

Ischaemic Colitis:
- large bowel
- less severe
- bloody diarrhoea
- thumbprinting
- conservative mx

Question 2

Factors predisposing to bowel ischaemia

Answer 2

• age
• AF
• other causes of emboli: endocarditis, malignancy
• smoking
• hypertension
• diabetes
• cocaine use

Question 3

Common clinical features of bowel ischaemia

Answer 3

• abdominal pain (out of character with exam findings)
• rectal bleeding
• diarrhoea
• fever
• raised WCC and lactic acidosis

Question 4

Diagnostic Ix of choice if suspecting bowel ischaemia

Answer 4

CT

Question 5

What other name is given to chronic mesenteric ischaemia?

Answer 5

Intestinal angina

Question 6

What is the definition of ischaemic colitis

Answer 6

• acute/transient compromise in blood flow to the large bowel

Leads to:
- inflammation
- ulceration
- haemorrhage

Question 7

Where is ischaemic colitis most likely to occur in the bowel?

Answer 7

‘watershed’ areas e.g. splenic flexure

i.e. located at the borders of the territory supplied by the superior and inferior mesenteric arteries

Question 8

What sign on AXR can indicate mucosal oedema/haemorrhage

Answer 8

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