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* Acute mesenteric Ischemia vs Ischemic colitis
 #824650  
  7th_dance - 03/30/16 12:04
 
  How to differentiate between these two?
 
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* Re:Acute mesenteric Ischemia vs Ischemic colitis
#3286679
  doctorhak - 03/30/16 14:34
 
  Acute Mesenteric ischemia is due to embolus lodging in mesenteric arteries subdivision.. specifically superior.. or by thrombosis of mesenteric veins...

where as Ischemic colitis is a condition in which any segment of bowel can become gangrenous either due to a tumor suppressing the blood flow or intussusception or volvulus or hernia..
 
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* Re:Acute mesenteric Ischemia vs Ischemic colitis
#3286753
  7th_dance - 03/30/16 21:08
 
  It sounds very straightforward when defining the two conditions separately but while doing questions they both sound very similar. So what are the things to look for in the question to make proper differentiation of the two?  
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* Re:Acute mesenteric Ischemia vs Ischemic colitis
#3286794
  cardio69 - 03/30/16 23:25
 
  MESENTERIC ISCHEMIA

-↓ intestinal blood flow -> ischemia & reperfusion injury
-SMA/Celiac axis/IMA
Acute:
-Thrombosis/Emboli/ HypOtension/ Shock / time vasoconstriction ( vasospasm) venous block from thrombosis
-On exam, pat pain out proportion ( hematochezia &/OR melena )
Chronic:
History of atherosclerotic
- As usual Nausea/vomiting/diarrhea
- Postprandial pain u ~about 30mins
- Stem usually tell your pat got history of A-fib, or some cardiac problem
- Weight loss AND YOU may hear the story of “FOOD FEAR” ( Pat comes with chronic abdominal pain right after meal/ u recall angina pain that like pain with exertion)

Dx;
CBC/leukocytosis, Lactic/or metabolic ACIDOSIS, Amylase UP.
Most accurate/ Arteriograph (always look for severe narrow 2 out of 3 mes vessels). Mesenteric duplex scanning. Ct angiography (out of scope of step 1 no worry), plain x-ray/portal venous gas, or you may told thumbprint sign… next step if you have pick in Q CT/W contrast venous and if norm -> angio for artery.

Treatment: YOU don’t need to know for step 1. Just know you can give; anticoagulation/venous thrombus, or surgery of embolic story.


ISCHEMIC COLITIS

You see pat L side abdominal pain with BLOODY DIARRHEA/[Note: in mild cases pat usually have blooding diarrhea but no abdominal pain] (due to mucosal or mural infarction) as u know MC site splenic flexure and rectum most commonly spared bz of rich collateral help. Often 2ndry underlining problem/MI or right following MI/postcardiopulmonary bypass/ post aortoiliac operation u may hear pat had repair on aortic/or mesenteric artery IMA story that postop and pat has bloody diarrhea & leukocytoses aneurysm /colitis and those Risk factor such as DM, hypOTN, vascular disease. Think about it like CI like acute infarction.

Dx;

Definitive by colon/sigmoidoscopy*, BE direct you mucosal ulcers bu now days CT taking over it that reveal colonic walls getting thick on affected area or in severe scenario portal venous gas or pneumatosis. Here you may wanna pay attn.; Angiograph not helpful bz major arterial block rare. *Sigmoidoscopy paint that pic dark/bloody mucosa/ but the risk of perforation high and that’s why if you hear pat got significant abdominal tenderness it no, no. Same as Gastrografin/BE on “acute phase” OF IC.

Treatment; Active watching it out, and depend on severity/ but for peritonitis w/gangrene/OR.

If you know my preach hear by heart not chance u miss any Qs on step 1 or CK.
 
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* Re:Acute mesenteric Ischemia vs Ischemic colitis
#3286810
  7th_dance - 03/31/16 00:57
 
  Thank you Cardio, this more than I expected.  
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* Re:Acute mesenteric Ischemia vs Ischemic colitis
#3286875
  cardio69 - 03/31/16 12:58
 
  Welcome.  
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