Ischemic colitis: Difference between revisions
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==Background== | |||
==Pearls== | ==Pearls== | ||
*''Consider ischemic colitis as the possible cause of '''acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities'''.'' | *''Consider ischemic colitis as the possible cause of '''acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities'''.'' | ||
*''For patients with peritoneal signs, radiographs should be considered for evaluation of '''ileus (air fluid levels), thumbprinting, pneumatosis coli, or pneumoperitoneum'''.'' | *''For patients with peritoneal signs, radiographs should be considered for evaluation of '''ileus (air fluid levels), thumbprinting, pneumatosis coli, or pneumoperitoneum'''.'' | ||
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{{Intestinal ischemia types}} | {{Intestinal ischemia types}} | ||
==Clinical Features== | |||
==Differential Diagnosis== | |||
==Evaluation== | |||
===Workup=== | |||
===Diagnosis=== | |||
==Management== | |||
==Disposition== | |||
==See Also== | |||
==External Links== | |||
[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net] Permission to reproduce via Creative Commons Attribution 4.0 International License per emDOCS.net | |||
==References== | |||
<references/> | |||
==See Also== | ==See Also== | ||
Revision as of 18:45, 8 July 2021
Background
Pearls
- Consider ischemic colitis as the possible cause of acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities.
- For patients with peritoneal signs, radiographs should be considered for evaluation of ileus (air fluid levels), thumbprinting, pneumatosis coli, or pneumoperitoneum.
- 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.
- Give antibiotics in suspected ischemic colitis if the patient has any of the factors associated with severe disease.
- 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.
Intestinal Ischemic Disorder Types
- 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
- Mesenteric venous thrombosis
- Chronic mesenteric ischemia ("intestinal angina")
Clinical Features
Differential Diagnosis
Evaluation
Workup
Diagnosis
Management
Disposition
See Also
External Links
Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net Permission to reproduce via Creative Commons Attribution 4.0 International License per emDOCS.net
References