ISCHEMIC COLITIS
WHAT IS ISCHEMIC COLITIS?
Ischemic colitis is injury of the large intestine that results from an
interruption of its blood supply. The term "ischemic colitis" can be broken down
into ischemia (referring to lack of oxygen) and colitis (referring to
inflammation of the colon). In people suffering from ischemic colitis, the inner
lining of the colon becomes irritated, inflamed and ulcerated due to a shortage
of oxygen-rich blood in the affected area.
Ischemic colitis is similar in nature to coronary artery disease: Both
conditions are caused by poor blood flow, one in the colon and the other in the
heart. Thus, some of the major risk factors for ischemic colitis are similar to
those for heart disease: high blood pressure, smoking and high cholesterol.
Ischemic colitis may result from sudden (acute) or, more commonly, long-term
(chronic) blockage of blood flow through arteries that supply the large
intestine. Blood clots can produce acute blockage; deposits of fatty material
(atherosclerosis) can lead to chronic blockage. Damage of the inside lining and
inner layers of the wall of the large intestine results; the degree of damage
depends on the duration and severity of the blockage. The damage produces ulcers
(sores) in the lining of the large intestine. Ischemic colitis affects primarily
people who are 50 or older.
Ischemic Colitis, also known as Colonic ischemia, is is injury of the large
intestine that results from an interruption of its blood supply. In people
suffering from ischemic colitis, the inner lining of the colon becomes
irritated, inflamed and ulcerated due to a shortage of oxygen-rich blood in the
affected area. Although this condition can affect any part of your colon, it
involves pain on the left side of the abdomen in most people with the condition.
Ischemic colitis occurs most often in people age 50 and older. Common signs or
symptoms of Ischemic Colitis include Abdominal pain, tenderness or cramping,
usually localized to the lower left side of your abdomen; the onset can be
sudden or gradual, Low-grade fever , Bright red or maroon-colored blood in your
stool or, at times, passage of blood without stool, A feeling of urgency to move
your bowels, Diarrhea, Nausea, or Vomiting.
WHAT ARE THE SYMPTOMS OF ISCHEMIC COLITIS?
Usually, the person experiences abdominal pain. The pain is felt more often on
the left side, but it can occur anywhere in the abdomen. The person frequently
passes loose stools that are often accompanied by dark red clots. Sometimes
bright red blood is passed without stool. Low-grade fevers (usually below 100° F
[37.7° C]) are common.
A doctor may suspect ischemic colitis on the basis of the symptoms, especially
in a person older than 50. An abdomen that is tender when pressed gently is
further evidence of ischemic colitis. A colonoscopy or barium enema is needed to
distinguish ischemic colitis from other forms of inflammation, such as infection
or inflammatory bowel disease.
WHAT CAUSES ISCHEMIC COLITIS?
The most common cause of Ischemic Colitis in minor cases is blood clots in the
arteries leading to your colon. Chronic cases are usually associated with the
buildup of fatty deposits in the blood vessels leading to your colon. Ischemic
Colitis may also be caused by or related to other medical conditions such as
Inflammation of the blood vessels (vasculitis), Protrusion of an organ or tissue
into the surrounding tissue, interfering with the arterial as well as the venous
blood supply to the intestine (hernia), Elevated sugar, or glucose, levels in
the blood (diabetes mellitus), Easy blood clotting (hypercoagulable state), and
Radiation treatment to the abdomen. Some disorders are considered predisposing
factors that place you at a bigger risk of developing ischemic colitis, or they
can aggravate it when it occurs. These include previous abdominal operations,
heart failure, strokes, low blood pressure and shock. The impaired blood flow
responsible for ischemic colitis is more likely to occur in people who have
traits or conditions commonly associated with coronary heart disease. These
include tobacco use, high blood pressure, and elevated cholesterol and
triglyceride levels.
HOW TO TREAT ISCHEMIC COLITIS?
Very mild cases of Ischemic Colitis can be managed on an outpatient basis with
liquid
diet, close observation, and antibiotics.
For inpatients, a combination of intravenous fluids and bowel rest is
recommended
to reduce intestinal oxygen requirements. Parenteral nutrition should be
considered for
patients who do not respond immediately and intestinal perfusion. Therefore,
digitalis and other vasopressors are withdrawn or minimized, if possible, and
cardiac output is maximized by adequate fluid resuscitation. Steroids have no
role in the treatment of
acute ischemia, and they serve only to mask the development of peritoneal signs
and delay a necessary laparotomy. Likewise, oral cathartics and bowel
preparations should not be given because of the risk of precipitating colonic
perforation
or toxic dilation of the colon.
MANAGING CHRONIC COLONIC ISCHEMIA
Chronic colonic ischemia is increasingly being recognized in the population at
large.
The patients are older and describe a history of bloody diarrhea associated with
crampy or constant episodes of abdominal pain. Endoscopy may suggest segmental
colitis.
Biopsy specimens of bullae show sub mucosal hemorrhage and edema, while
intervening areas reveal nonspecific inflammation. Venous congestion, mucus
depletion, and injury to the crypt architecture and surface epithelial cells are
also common.
The diagnosis is not always easy, however, and chronic ischemic colitis can
easily be mistaken for inflammatory bowel disease. Compounding the difficulty,
pseudopolyposis
may be present in patients with ischemic colitis. Patients may also develop
ischemic strictures, which are classically smoother than neoplastic strictures;
however, differentiation is not always easy and resection may be required, both
for treatment of symptoms and to obtain a definitive histopathologic diagnosis.
Mildly symptomatic chronic disease frequently responds to supportive management.
In contrast to acute ischemia, chronic ischemia may respond to topical steroid
preparations. Resectional surgery is generally reserved for patients for whom
conservative supportive therapy fails and for those with recurrent episodes of
colitis or with symptomatic strictures. As in surgery for acute ischemia, the
respected specimen must be examined to confirm
that the mucosa is normal at the resection margins, and pulsatile bleeding must
be
noted from the bowel ends. Surgery in patients with chronic ischemia usually is
curative,
and development of further ischemic disease is rare.

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