Ischemic Colitis

Ischemic Colitis is a sudden swelling or inflammation of a part of the large intestine (colon) that occurs when there is a temporary loss of, or reduction in, blood flow to the colon. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia.

The arteries that supply blood to the colon are like any other artery in the body. They have the tendency to narrow due to atherosclerosis (just like blood vessels in the heart, which can cause angina, or narrowed vessels in the brain can cause a stroke). When these arteries narrow, the colon loses its blood supply and becomes inflamed.

Causes of the reduced blood flow can include changes in the systematic circulation or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.

The colon can also lose its blood supply for mechanical reasons. Examples would include: volvulus, in which the bowel twists on itself, or an incarcerated hernia in which a portion of the colon gets stuck in an outpouching of the abdominal wall.

In patients who are at risk for decreased blood flow to the colon, ischemic colitis can occur if the blood pressure falls. This may occur with dehydration, anemia, or shock. Ishcemia or lack of blood supply causes significant pain, fever, and bloody bowel movements.

Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed via endoscopy or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter. Ischemic colitis can span a wide variety of severity; most of the patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill.

People with mild to moderate ischemic colitis are usually treated with IV fluids, analgesia, and bowel rest until the symptoms resolve. But for those with severe ischemia who develop complications such as sepsis, intestinal gangrene, or bowel perforation may require more aggressive interventions such as surgery and intensive care. Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a stricture or chronic colitis.

There are 3 progressive phases associated with ischemic colitis:

• Hyperactive phase – this occurs first. This is the phase wherein the primary symptoms are severe abdominal pain and the passage of bloody stools. There are many patients that do get better and do not progress beyond this phase.
• Paralytic phase – this would follow next if ischemia continues. This is the phase where abdominal pain becomes more widespread, the belly feels more tender to touch, and bowel motility decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam.
• Shock phase – This would develop as fluids start to leak through the damaged colon lining. This can result in shock and metabolic acidosis with dehydration, low blood pressure, rapid heart rate, and confusion. Patients who progress to this phase are often critically ill and require intensive care.

-- VDoctor

Ischemic Colitis Recommended Resources:

University of Maryland Medical Center

Cornell University

John Adams 15.04.09 at 08:04am

nigneeftore 07.06.10 at 10:38am

LellortotaLew 07.06.10 at 22:02pm

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