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Ischemic colitis (Diagnosis (Investigations (Bloods FBC (anaemia), CRP, …
Ischemic colitis
Diagnosis
History
PC/HPC: pain, PR bleed, shock
PMH: CVD/PVD
DH: meds
FH: CVD, PVD
SH: smoking, alcohol
Examination
Abdo: often nil
PR: PR fresh blood
Investigations
Bloods
FBC (anaemia), CRP, U+E, LFT, amylase,
G+S/CM, clotting, lactate (raised), glucose, lipids
Bedside
Obs (may be shock if necrotic/gengrenous)
Imaging
CT angiography: diagnostic
Barium enema: thumbprinting of
colonic submucosa (swelling)
Clinical
presentation
Pain
Site: LLQ
Onset: acute
Character: colicky
Radiation: nil
Associated: PR bleed
Timing: constant
Exacerbating/relieving: eating if chronic,
nil if acute
Severity: SEVERE
PR bleed
Fresh PR blood
Management
Definitive
Medical
Analgesia
IV fluids
Abx
Surgical
Resection of ischemic/gangrenous colon
Conservative
NBM until senior r/v
Referral to surgeons
Initial A to E
Complications
Acute
Shock
Perforation
Chronic
Strictures
Definition
Chronic ischemia of the colon
Pathophysiology
Ischemia of the IMA, causing blocked
blood supply to the colon
Ranges from acute ischemia to necrosis
I.e. ranges from angina of colon to MI