Ischemic colitis: Difference between revisions
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==Background== | ==Background== | ||
{{Intestinal ischemia types}} | {{Intestinal ischemia types}} | ||
==Clinical Features== | ==Clinical Features== | ||
*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> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
===Workup=== | ===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> | |||
*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=== | ===Diagnosis=== | ||
==Management== | ==Management== | ||
*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> | |||
==Disposition== | ==Disposition== | ||
Revision as of 18:50, 8 July 2021
Background
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
- 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]
Differential Diagnosis
Colitis
- Infectious colitis
- Ischemic colitis
- Ulcerative colitis
- CMV colitis
- Crohn's colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Fibrosing colonopathy (Cystic fibrosis)
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Evaluation
Workup
- 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]
Diagnosis
Management
- 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]
Disposition
See Also
External Links
References
- ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
- ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
- ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
- ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net
- ↑ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net