Ischemic colitis: Difference between revisions

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==Background==
==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.<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 ischemic colitis as the possible cause of '''acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities'''.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
*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>
*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>
*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>
*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>
*Give antibiotics in suspected ischemic colitis if the patient has any of the factors associated with severe disease.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
*Give '''antibiotics''' in suspected ischemic colitis if the patient has '''any of the factors associated with severe disease'''.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
*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.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
*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'''.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>


{{Intestinal ischemia types}}
{{Intestinal ischemia types}}

Revision as of 18:49, 8 July 2021

Background

  • 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]
  • For patients with peritoneal signs, radiographs should be considered for evaluation of ileus (air fluid levels), thumbprinting, pneumatosis coli, or pneumoperitoneum.[2]
  • 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.[3]
  • Give antibiotics in suspected ischemic colitis if the patient has any of the factors associated with severe disease.[4]
  • 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.[5]

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

Clinical Features

Differential Diagnosis

Colitis

Diffuse Abdominal pain

Evaluation

Workup

Diagnosis

Management

Disposition

See Also

External Links

References

  1. ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
  2. ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
  3. ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
  4. ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
  5. ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net


See Also

References

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