Ischemic colitis history and symptoms: Difference between revisions

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{{Ischemic colitis}}
{{Ischemic colitis}}
{{CMG}}; {{AOEIC}} {{CZ}}
{{CMG}}; {{AE}} {{HQ}}


==Overview==
==Overview==
Ischemic colitis is characterized by [[abdominal pain]] which is out of proportion to physical findings, specifically excruciating abdominal pain despite limited focal tenderness.
Ischemic colitis is characterized by [[abdominal pain]] which is out of proportion to [[Physical examination|physical]] findings. There is a sudden onset of crampy [[abdominal pain]], [[diarrhea]], and an urge to [[Defecation|defecate]]. The [[pain]] is mild, located over the affected [[Intestine|bowel]], and usually to the left side of the lower [[abdomen]]. Mild [[rectal bleeding]] is noticed within 24 hours which may be bright red or maroon mixed with the [[Human feces|stools]].  


==History and Symptoms==
==History and Symptoms==
Three progressive phases of ischemic colitis have been described:<ref>{{cite journal |author=Boley SJ, Brandt LJ, Veith FJ |title=Ischemic disorders of the intestines |journal=Curr Probl Surg |volume=15 |issue=4 |pages=1–85 |year=1978 |month=April |pmid=365467 |doi=10.1016/S0011-3840(78)80018-5}}</ref><ref>{{cite journal | author = Hunter G, Guernsey J | title = Mesenteric ischemia. | journal = Med Clin North Am | volume = 72 | issue = 5 | pages = 1091–115 | year = 1988 | pmid = 3045452}}</ref>
The history and symptoms of ischemic colitis are as follows:<ref name="TheodoropoulouΚoutroubakis2008">{{cite journal|last1=Theodoropoulou|first1=Αngeliki|last2=Κoutroubakis|first2=Ioannis E|title=Ischemic colitis: Clinical practice in diagnosis and treatment|journal=World Journal of Gastroenterology|volume=14|issue=48|year=2008|pages=7302|issn=1007-9327|doi=10.3748/wjg.14.7302}}</ref><ref>{{cite journal |author=Boley SJ, Brandt LJ, Veith FJ |title=Ischemic disorders of the intestines |journal=Curr Probl Surg |volume=15 |issue=4 |pages=1–85 |year=1978 |month=April |pmid=365467 |doi=10.1016/S0011-3840(78)80018-5}}</ref><ref>{{cite journal | author = Hunter G, Guernsey J | title = Mesenteric ischemia. | journal = Med Clin North Am | volume = 72 | issue = 5 | pages = 1091–115 | year = 1988 | pmid = 3045452}}</ref><ref name="Greenwald">{{cite journal | author = Greenwald D, Brandt L, Reinus J | title = Ischemic bowel disease in the elderly. | journal = Gastroenterol Clin North Am | volume = 30 | issue = 2 |pages = 445–73 | year = 2001 | pmid = 11432300 | doi = 10.1016/S0889-8553(05)70190-4}}</ref><ref name="pmid17071206">{{cite journal |author=Huguier M, Barrier A, Boelle PY, Houry S, Lacaine F |title=Ischemic colitis |journal=Am. J. Surg.|volume=192 |issue=5 |pages=679–84 |year=2006 |pmid=17071206 | doi=10.1016/j.amjsurg.2005.09.018}}</ref>
* Sudden onset of crampy [[abdominal pain]], [[diarrhea]], and an urge to [[Defecation|defecate]]
** The pain is mild, located over the affected [[Intestine|bowel]], usually to the left side of the lower [[abdomen]]
** Mild [[rectal bleeding]] within 24 hours
* The [[blood]] may be bright red or maroon mixed with the [[Human feces|stools]]
* [[Rectal bleeding]] is minimal
* [[Hematochezia]] with [[Hemodynamics|hemodynamic]] instability suggests a different diagnosis
* Associated [[ileus]] may be manifested by [[anorexia]], [[Nausea and vomiting|nausea]] and [[Nausea and vomiting|vomiting]]


===Hyperactive Phase===
===Common Symptoms===
*A hyperactive phase occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase.
* Symptoms of ischemic colitis vary depending on the severity of the [[ischemia]]  
 
* The most common early signs of ischemic colitis include [[abdominal pain]] (often left-sided), with mild to moderate amounts of [[lower gastrointestinal bleeding|rectal bleeding]]  
===Paralytic Phase===
* The sensitivity of findings among 73 patients were as follows:
*A paralytic phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel [[motility]] decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam.
** [[Abdominal pain]]: 78% of patients
 
** [[Lower digestive bleeding]]: 62% of patients
===Shock Phase===
** [[Diarrhea]]: 38% of patients
*Finally, a shock phase can develop as fluids start to leak through the damaged colon lining. This can result in [[Shock (circulatory)|shock]] and [[metabolic acidosis]] with [[dehydration]], [[hypotension|low blood pressure]], [[tachycardia|rapid heart rate]], and confusion. Patients who progress to this phase are often critically ill and require [[intensive care]].
** [[Fever]]: Higher than 100.4°F (38°C) in 34% of patients


===Common Symptoms===
===Less common symptoms===
Symptoms of ischemic colitis vary depending on the severity of the ischemia. The most common early signs of ischemic colitis include [[abdominal pain]] (often left-sided), with mild to moderate amounts of [[lower gastrointestinal bleeding|rectal bleeding]].<ref name="Greenwald">{{cite journal | author = Greenwald D, Brandt L, Reinus J | title = Ischemic bowel disease in the elderly. | journal = Gastroenterol Clin North Am | volume = 30 | issue = 2 |pages = 445–73 | year = 2001 | pmid = 11432300 | doi = 10.1016/S0889-8553(05)70190-4}}</ref> The sensitivity of findings among 73 patients were:<ref name="pmid17071206">{{cite journal |author=Huguier M, Barrier A, Boelle PY, Houry S, Lacaine F |title=Ischemic colitis |journal=Am. J. Surg.|volume=192 |issue=5 |pages=679–84 |year=2006 |pmid=17071206 | doi=10.1016/j.amjsurg.2005.09.018}}</ref>
*Chills / rigors
* [[Abdominal pain]]: 78% of patients
*Cachexia
* [[Lower digestive bleeding]]: 62% of patients
* [[Diarrhea]]: 38% of patients
* [[Fever]]: Higher than 38°C in 34% of patients (38°C equals approximately 100.4°F)


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 14:32, 5 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Ischemic colitis is characterized by abdominal pain which is out of proportion to physical findings. There is a sudden onset of crampy abdominal pain, diarrhea, and an urge to defecate. The pain is mild, located over the affected bowel, and usually to the left side of the lower abdomen. Mild rectal bleeding is noticed within 24 hours which may be bright red or maroon mixed with the stools.

History and Symptoms

The history and symptoms of ischemic colitis are as follows:[1][2][3][4][5]

Common Symptoms

Less common symptoms

  • Chills / rigors
  • Cachexia

References

  1. Theodoropoulou, Αngeliki; Κoutroubakis, Ioannis E (2008). "Ischemic colitis: Clinical practice in diagnosis and treatment". World Journal of Gastroenterology. 14 (48): 7302. doi:10.3748/wjg.14.7302. ISSN 1007-9327.
  2. Boley SJ, Brandt LJ, Veith FJ (1978). "Ischemic disorders of the intestines". Curr Probl Surg. 15 (4): 1–85. doi:10.1016/S0011-3840(78)80018-5. PMID 365467. Unknown parameter |month= ignored (help)
  3. Hunter G, Guernsey J (1988). "Mesenteric ischemia". Med Clin North Am. 72 (5): 1091–115. PMID 3045452.
  4. Greenwald D, Brandt L, Reinus J (2001). "Ischemic bowel disease in the elderly". Gastroenterol Clin North Am. 30 (2): 445–73. doi:10.1016/S0889-8553(05)70190-4. PMID 11432300.
  5. Huguier M, Barrier A, Boelle PY, Houry S, Lacaine F (2006). "Ischemic colitis". Am. J. Surg. 192 (5): 679–84. doi:10.1016/j.amjsurg.2005.09.018. PMID 17071206.

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