Ichaemic Colitis

Exam Cram

• Ischaemic colitis: ischaema t

• Presentation: severe abdominal pain & raised lactate

• Diagnosis: CT Angio- arterial colonic narrowing

• Management: supportive- IVF, analgesia or colectomy

Outline

Background 

Areas typically affected reflect watershed between arteries

1. Splenic flexture - SMA vs IMA

2. Recto-sigmoid junction- IMA vs rectal arteries

Assessment

History:

• Abdominal pain (severe) and diarrhoea

• Background: vasculopath- previous arterial disease- MI, Stroke; PVD, smoker

• Cocaine 

Examination:

• Tender abdomen, soft

• HR raised, BP low

Investigations

• Lactate raised

• Mildly raised CRP/ neutrophils

Diagnosis

Diagnostic criteria: clinical- symptoms + imaging

Differentials: Pancreatitis, Bowel perforation, Diverticulitis, 

• Other colitis causes: infective, inflammatory, microscopic

Classification: severity- lactate, degree of Hypotension 

Management

Acute

1. IVF

2. Analgesia

3. Colectomy if risk of colonic rupture

Long term (atheromatous secondary prevention)

• Lifestyle advice: smoking cessation, reduce alcohol, low fat/ salt diet

• Medication: statin, BP control

References and Resources

Page written in 2024.