mesenteric ischaemia and ischaemic colitis

Question 1

where does ischaemic colitis usually occur?

Answer 1

Affects large bowel and occurs in ‘watershed’ areas e.g. splenic flexure

Question 2

where does mesenteric ischaemia affect?

Answer 2

small bowels

Question 3

how does presentation of mesenteric ischaemia differ from ischaemic colitis?

Answer 3

mesenteric ischaemia= severe sudden abode pain disporportionate to abdominal findings

but ischaemic colitis is less severe transient pain with bloody diarrhoea

Question 4

what is the diagnostic test for mesenteric ischaemia vs ischaemic colitis?

Answer 4

mesenteric ischaemia= CT angiogram

ischaemic colitis= colonoscopy is gold standard but a AXR may show thumbprint sign

Question 5

how does the management of mesenteric ischamia differ from management of ischaemic colitis?

Answer 5

mesenteric ischaemia= surgical emergency requiring endocascular therapy, embolectomy, bypass or bowel resection. anticoagulation such as IV heparin can also be given

ischaemic colitis= can be managed conservatively, but escalate to surgical if conservative management fails

Question 6

how do the outcomes of mesenteric ischaemia and ischaemic colitis differ?

Answer 6

mesenteric ischaemia:
Acute: high mortality if untreated

Chronic: manage cardiovascular risk factors and elective revascularisation may be arranged

ischameic colitis:
Most patients’ symptoms improve within 24 to 48 hours, with complete clinical recovery within 1 to 2 weeks
Overall mortality is ∼22%