Ischaemic bowel disease Flashcards Preview

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Flashcards in Ischaemic bowel disease Deck (18)
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1
Q

Frequent site of ischaemic colitis?

A

Splenic flexure. Site at which arterial anastomoses are least well developed.

2
Q

What are the clinical features of ischaemic colitis?

A

Symptoms: Acute left sided abdominal pain, dark red rectal bleeding.
Signs: fever, hypotension, abdominal tenderness.

3
Q

Ix in ischaemic colitis?

A

AXR: distended splenic flexure (oedematous mucosa may be detected).
CT/barium enema: thumb printing of mucosa apparent.

4
Q

Mx of ischaemic colitis?

A

Spontaneous resolution.

Occasionally gangrene requires emergency surgery (ischamia –> stricture –> gangrene).

5
Q

What is ischaemic bowel diseae?

A

Diverse group of heterogenous disorders that may be acute or chronic; occlusive or non-occlusive in aetiology; result in decreased blood flow to GIT.

6
Q

What are the forms of arterial compromise precipitating ischaemic bowel disease?

A
  • Embolism: 50% cases.
  • Thrombosis: 15-20%
  • Vasculitis
  • External compression: rare
7
Q

Describe the pathophysiology of arterial thrombosis precipitating ischaemic bowel.

A

Thrombus occurring as progression of atherosclerosis at origin of SMA. Sub acute or chronic ischaemia may result from partial occlusion of the vessel.

8
Q

Which conditions can lead to vasculitis causing ischaemia of the bowel?

A

RA, polyarteritis nodosa, SLE, dermatomyositis, Takayasu.

9
Q

What is the aetiology of ischaemic bowel disease?

A
  • Arterial compromise
  • Venous compromise
  • Hypoperfusion (shock/hypotension/surgery/infection).
10
Q

Which areas in the bowel are watershed areas?

A

-Splenic flexure
-Recto-sigmoid junction
Collaterisation of blood flow may be limited

11
Q

What occurs as a result of bowel ischaemia?

A

Mucosal sloughing, ulceration, bacterial translocation.
Reperfusion injury may occur.
Healing may result in stenosis or stricture.

12
Q

Which artery is generally affected by thromboembolic events leading to ischaemic bowel?

A

SMA. Lies more vertically on the aorta than the other vessels (IMA and coeliac artery) which are positioned more obliquely.

13
Q

What are the RFx for ischaemic bowel disease?

A
  • Old age
  • Smoking
  • Hypercoaguability
  • AF
  • MI
  • Vasculitis
14
Q

Ix in ischaemic bowel disease?

A

FBE: leukocytosis, anaemia, haemoconcentration
ABGs: acidosis, elevated lactate
Chemistry panel: acidosis, uraemia, elevate creatinine
ECG: AF, arrhythmia, MI
CXR: free air if perforation
AXR: air fluid levels, bowel dilation, bowel wall thickening
Colonoscopy: mucosal sloughing/friability, mucosal petechiae, erosions/ulcerations.

15
Q

DDx ischaemic bowel disease?

A

Infectious colitis, UC/CD, diverticular disease

16
Q

How should acute ischaemic bowel be treated with evidence of infarction/perforation/peritonitis?

A
  • Resuscitation and supportive measures
  • Empiric ABx (ceftriaxone 1g IV/24 + metronidazole 500mg IV tds).
  • Laparoscopy
17
Q

What are the supportive measures needed in ischaemic bowel disease?

A
  • Bowel rest
  • NGT
  • NPO status
  • IV fluids
  • O2 as required
  • Correct hypotension/CCF/arrhythmias
  • Close observation (e.g. for peritonitis)
18
Q

How should acute ischaemic bowel be managed with no evidence of infarction/perforation/peritonitis?

A
  • Supportive measures

- Empiric ABx