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GI > ISCHEMIC BOWEL > Flashcards

ISCHEMIC BOWEL Flashcards

1
Q

what is colonic ischemia?

A

mesenteric ischemia of colon leads to inflammation and sloughing of the intestinal mucosa

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2
Q

where is the most common area to see colonic ischemia?

A

splenic flexture and rectosigmoid junction (watershed areas)

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3
Q

what are the RF for colonic ischemia?

A
  • > 60 F
  • ASCVD
  • CHF
  • recent AAA surgery
  • hx constipation
  • hx HTN RX (esp vasoconstrictive)
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4
Q

what is the presentation of colonic ischemia?

A
  • LLQ pain
  • hematochezia (bloody diarrhea): typically self limited
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5
Q

what will you see on PE of colonic ischemia?

A
  • LLQ tenderness- watch for peritoneal signs/fever (usually absent)
  • absent/hypoactive bowel signs
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6
Q

what is the workup of colonic ischemia?

A
  1. CTA or MRA: intestinal ischemia; bowel wall edema; “thumb-printing”: segmental bowel wall thickening
  2. colonoscopy: ischemic changes to mucosa (GOLD STANDARD), edematous/friable tissue, can bx.
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7
Q

will you perfrom colonoscopy in suspected bowel perf or with peritoneal signs?

A

DO NOTTTT; pushing air up will make them sicker

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8
Q

What is the tx of colonic ischemia?

A
  1. IV fluids
  2. stable BP- avoid further hypotension/low flow state
    - will usually resolve with supportive care
  3. consider empiric broad spectrum abx
    - coverage of gram neg and anaerobes
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9
Q

what is acute mesenteric ischemia?

A

inadequate perfusion through mesenteric vessels (embolic, low flow state) can lead to gangrene of bowel
fatal w/o intervention

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10
Q

what are the RF for acute mesenteric ischemia?

A

a fib
ascvd
recent MI
valvular dz
elderly
abd malignancy
hypercoagulability
paradoxical venous embolism -> shunt

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11
Q

what is the presentation of acute mesenteric ischemia?

A
  • ACUTE SEVERE ABD PAIN w/ unremarkable PE
  • N/V +/- GIB
  • if have chronic ischemia may have postprandial abd pain, “food fear” and wt loss
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12
Q

what will you see on PE of acute mesenteric ischemia?

A

+/- peritoneal signs if perforation

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13
Q

what is the work up of acute mesenteric ischemia?

A
  1. leukocytosis, elevated lactate (depending on stage of dz), lactic acidosis
  2. abd CT often unremarkable (can help r/o perf, diverticulitis, obstruction, appendicitis, abscess)
  3. CTA IS GOLD STANDARD: NARROWING OF PROXIMAL VESSELS
  4. MRA: increase cost, time
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14
Q

what work up is the gold standard for acute mesenteric ischemia?

A

CTA IS GOLD STANDARD: NARROWING OF PROXIMAL VESSELS

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15
Q

what is the tx of acute mesenteric ischemia?

A
  1. restore flow w/ anticoag/thrombolysis if occlusive ischemia; angioplasty/stenting/bypass
  2. if bowel ischemia needs immediate exploratory surgery and if bowel viable poss bypass
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16
Q

what is colonic volvulus?

A

life threatening emergency when colon twists creating colonic obstruction or vascular compromise

17
Q

what is most commonly involved in colonic volvulus?

A

sigmoid

18
Q

can colonic volvulus be recurrent?

A

obviouslyyyy

19
Q

what are the RF for colonic volvulus?

A

elderly
bedridden
ovarian or pelvic mass
pregnancy
dementia
psychiatric impairment
hx previous volvulus

20
Q

what is the presentation of colonic volvulus?

A

acute, colicky abdominal pain, abdominal distention, obstipation, N/V

21
Q

what does the PE of colonic volvulus show?

A

largely distended, tympanic abdomen: if rebound tenderness consider peritonitis from perforation

22
Q

what is the work up of colonic volvulus?

A
  • leukocytosis
  • xray abd: u- shaped distended sigmoid colon
  • CT: dilated sigmoid colon, “bird beak” appearance
  • barium enema, c-scope can aid in dx
23
Q

what is the tx of sigmoid volvulus?

A

decompression via sigmoidoscopy then consider surgical resection

24
Q

what is the tx of cecal volvulus?

A

do not try to reduce/decompress- straight to surgery (huger risk for perforation and ischemia)

25
Q

what is the tx of peritonitis or ischemic bowel?

A

IVF, analgesia, abx and surgical resection
- life threatening

GI (22 decks)

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