Ischemic colitis: Difference between revisions

Revision as of 18:50, 8 July 2021

Ischemic colitis
- Accounts for 80-85% of intestinal ischemia
- Due to non-occlusive disease with decreased blood flow to the colon.
- Causes decreased perfusion leading to sub-mucosal or mucosal ischemia only.
- Typical to the "watershed areas" of the colon (Splenic flexure or Sigmoid)

Acute mesenteric ischemia
- Due to complete occlusion of mesenteric vessels
- Complete transmural ischemia

Consider ischemic colitis as the possible cause of acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities.^[1]

Give antibiotics in suspected ischemic colitis if the patient has any of the factors associated with severe disease.^[3]
Place an emergent surgical consultation for any patient with peritoneal signs on physical exam or pneumatosis coli, portal venous gas, pan-colonic distribution, or isolated right-colon ischemia on imaging.^[4]

Authors:

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 ==Evaluation==
 ===Workup===
-*For patients with peritoneal signs, radiographs should be considered for evaluation of ileus (air fluid levels), thumbprinting, pneumatosis coli, or pneumoperitoneum.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
+*CTA (first-line imaging)<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
-*Consider ordering a CTA as first-line imaging, especially if there is any suggestion of mesenteric ischemia, right sided tenderness without hematochezia, or if you suspect severe disease. If resources do not allow, order a CT with oral and IV contrast. If IRCI is incidentally found on initial CT, then CTA can be deferred to the inpatient setting and obtained prior to discharge.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
 ===Diagnosis===