Ischemic colitis classification: Difference between revisions

Colitis Main Page
	Ischemic colitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Ischemic colitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Abdominal X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Ischemic colitis classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ischemic colitis classification All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA onIschemic colitis classification
CDC on Ischemic colitis classification
Ischemic colitis classification in the news
Blogs on Ischemic colitis classification
Directions to Hospitals Treating Ischemic colitis
Risk calculators and risk factors for Ischemic colitis classification

VisualWikitext

Latest revision as of 14:06, 5 February 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]; Mehrian Jafarizade, M.D [3]

Overview

Ischemic colitis may be classified on the degree of the histopathological damage in the colonic wall as reversible ischemic colopathy (submucosal or intramural bleeding), transient colitis, chronic segmental ischemia, gangrenous colitis, and universal fulminant colitis. Also, based on its clinical course into two types: acute ischemic colitis or chronic ischemic colitis.

Classification

Ischemic colitis can be classified into the following types based on clinical features of disease:^[1]^[2]^[3]^[4]

Reversible ischemic colopathy

Characterized by submucosal hemorrhage at endoscopy, with involvement of superficial mucosa
Self-limiting

Transient (most common form)

Present with abdominal pain, rectal bleeding and full-thickness involvement of the mucosa

Chronic segmental or chronic ulcerative

Persistent symptoms or recurrent episodes of pain, rectal bleeding, diarrhea, and segmental colitis on imaging
Resection is usually curative

Ischemic colonic stricture

Found at follow-up endoscopy

Gangrenous colitis

Suspected when there is increasing abdominal pain, signs of local or generalized peritonitis, fever or ileus

Universal fulminant pancolitis

Presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon
Results in sepsis and perforation
75% mortality rate
Symptoms include sepsis, severe abdominal pain, peritonitis and rectal bleeding

Percentage for each type:

Classification of ischemic colitis by percentage
Type	Percentage (%)
Reversible ischemic colopathy	3-26.1
Transient	45
Chronic segmental or ulcerative	17.9-25
Ischemic colonic stricture	10-15
Gangrenous colitis	9.9-19
Universal fulminant pancolitis	1-2.5

Ischemic colitis can be classified into the following types based on clinical course of disease:

Acute ischemic colitis

Occlusive
- Due to arterial or venous thrombosis blocking blood supply
Non-Occlusive
- Due to hypoperfusion of the colon

Chronic ischemic colitis

Ischemic colitis

Acute ischemic colitis

Chronic ischemic colitis

Occlusive

Non-occlusive

References

↑ Hunter GC, Guernsey JM (1988). "Mesenteric ischemia". Med. Clin. North Am. 72 (5): 1091–115. PMID 3045452.
↑ Nikolic, Amanda L.; Keck, James O. (2017). "Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management". ANZ Journal of Surgery. doi:10.1111/ans.14237. ISSN 1445-1433.
↑ Montoro, Miguel A.; Brandt, Lawrence J.; Santolaria, Santos; Gomollon, Fernando; Puértolas, Belén Sánchez; Vera, Jesús; Bujanda, Luis.; Cosme, Angel; Cabriada, José Luis; Durán, Margarita; Mata, Laura; Santamaría, Ana; Ceña, Gloria; Blas, Jose Manuel; Ponce, Julio; Ponce, Marta; Rodrigo, Luis; Ortiz, Jacobo; Muñoz, Carmen; Arozena, Gloria; Ginard, Daniel; López-Serrano, Antonio; Castro, Manuel; Sans, Miquel; Campo, Rafael; Casalots, Alex; Orive, Víctor; Loizate, Alberto; Titó, Lluçia; Portabella, Eva; Otazua, Pedro; Calvo, M.; Botella, Maria Teresa; Thomson, Concepción; Mundi, Jose Luis; Quintero, Enrique; Nicolás, David; Borda, Fernando; Martinez, Benito; Gisbert, Javier P.; Chaparro, María; Bernadó, Alfredo Jimenez; Gómez-Camacho, Federico; Cerezo, Antonio; Nuñez, Enrique Casal (2010). "Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)". Scandinavian Journal of Gastroenterology. 46 (2): 236–246. doi:10.3109/00365521.2010.525794. ISSN 0036-5521.
↑ O’Neill, Stephen; Elder, Kenny; Harrison, Sarah J.; Yalamarthi, Satheesh (2011). "Predictors of severity in ischaemic colitis". International Journal of Colorectal Disease. 27 (2): 187–191. doi:10.1007/s00384-011-1301-x. ISSN 0179-1958.

Template:WH Template:WS

[pmid3045452-1] Hunter GC, Guernsey JM (1988). "Mesenteric ischemia". Med. Clin. North Am. 72 (5): 1091–115. PMID 3045452.

[NikolicKeck2017-2] Nikolic, Amanda L.; Keck, James O. (2017). "Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management". ANZ Journal of Surgery. doi:10.1111/ans.14237. ISSN 1445-1433.

[MontoroBrandt2010-3] Montoro, Miguel A.; Brandt, Lawrence J.; Santolaria, Santos; Gomollon, Fernando; Puértolas, Belén Sánchez; Vera, Jesús; Bujanda, Luis.; Cosme, Angel; Cabriada, José Luis; Durán, Margarita; Mata, Laura; Santamaría, Ana; Ceña, Gloria; Blas, Jose Manuel; Ponce, Julio; Ponce, Marta; Rodrigo, Luis; Ortiz, Jacobo; Muñoz, Carmen; Arozena, Gloria; Ginard, Daniel; López-Serrano, Antonio; Castro, Manuel; Sans, Miquel; Campo, Rafael; Casalots, Alex; Orive, Víctor; Loizate, Alberto; Titó, Lluçia; Portabella, Eva; Otazua, Pedro; Calvo, M.; Botella, Maria Teresa; Thomson, Concepción; Mundi, Jose Luis; Quintero, Enrique; Nicolás, David; Borda, Fernando; Martinez, Benito; Gisbert, Javier P.; Chaparro, María; Bernadó, Alfredo Jimenez; Gómez-Camacho, Federico; Cerezo, Antonio; Nuñez, Enrique Casal (2010). "Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)". Scandinavian Journal of Gastroenterology. 46 (2): 236–246. doi:10.3109/00365521.2010.525794. ISSN 0036-5521.

[O’NeillElder2011-4] O’Neill, Stephen; Elder, Kenny; Harrison, Sarah J.; Yalamarthi, Satheesh (2011). "Predictors of severity in ischaemic colitis". International Journal of Colorectal Disease. 27 (2): 187–191. doi:10.1007/s00384-011-1301-x. ISSN 0179-1958.

[1]

[2]

[3]

[4]

@@ Line 5: / Line 5: @@
 ==Overview==
-Ischemic colitis may be classified largely on the degree of the histopathological damage in the colonic wall: reversible colopathy (submucosal or intramural bleeding), transient colitis, chronic segmental ischemia, gangrenous colitis, and universal fulminant colitis. Also, based on its clinical course into two types: acute ischemic colitis or chronic ischemic colitis.
+Ischemic colitis may be classified on the degree of the [[Histopathology|histopathological]] damage in the [[Colon (anatomy)|colonic]] wall as reversible ischemic colopathy ([[Submucosa|submucosal]] or intramural bleeding), transient colitis, chronic segmental [[ischemia]], [[Gangrene|gangrenous]] [[colitis]], and universal [[fulminant]] [[colitis]]. Also, based on its clinical course into two types: [[Acute (medicine)|acute]] [[Ischemia|ischemic]] [[colitis]] or [[Chronic (medical)|chronic]] [[Ischemia|ischemic]] [[colitis]].
-==History and Symptoms==
+==Classification==
-Ischemic colitis can be classified into:<ref name="pmid3045452">{{cite journal |vauthors=Hunter GC, Guernsey JM |title=Mesenteric ischemia |journal=Med. Clin. North Am. |volume=72 |issue=5 |pages=1091–115 |year=1988 |pmid=3045452 |doi= |url=}}</ref><ref name="NikolicKeck2017">{{cite journal|last1=Nikolic|first1=Amanda L.|last2=Keck|first2=James O.|title=Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management|journal=ANZ Journal of Surgery|year=2017|issn=14451433|doi=10.1111/ans.14237}}</ref><ref name="MontoroBrandt2010">{{cite journal|last1=Montoro|first1=Miguel A.|last2=Brandt|first2=Lawrence J.|last3=Santolaria|first3=Santos|last4=Gomollon|first4=Fernando|last5=Puértolas|first5=Belén Sánchez|last6=Vera|first6=Jesús|last7=Bujanda|first7=Luis.|last8=Cosme|first8=Angel|last9=Cabriada|first9=José Luis|last10=Durán|first10=Margarita|last11=Mata|first11=Laura|last12=Santamaría|first12=Ana|last13=Ceña|first13=Gloria|last14=Blas|first14=Jose Manuel|last15=Ponce|first15=Julio|last16=Ponce|first16=Marta|last17=Rodrigo|first17=Luis|last18=Ortiz|first18=Jacobo|last19=Muñoz|first19=Carmen|last20=Arozena|first20=Gloria|last21=Ginard|first21=Daniel|last22=López-Serrano|first22=Antonio|last23=Castro|first23=Manuel|last24=Sans|first24=Miquel|last25=Campo|first25=Rafael|last26=Casalots|first26=Alex|last27=Orive|first27=Víctor|last28=Loizate|first28=Alberto|last29=Titó|first29=Lluçia|last30=Portabella|first30=Eva|last31=Otazua|first31=Pedro|last32=Calvo|first32=M.|last33=Botella|first33=Maria Teresa|last34=Thomson|first34=Concepción|last35=Mundi|first35=Jose Luis|last36=Quintero|first36=Enrique|last37=Nicolás|first37=David|last38=Borda|first38=Fernando|last39=Martinez|first39=Benito|last40=Gisbert|first40=Javier P.|last41=Chaparro|first41=María|last42=Bernadó|first42=Alfredo Jimenez|last43=Gómez-Camacho|first43=Federico|last44=Cerezo|first44=Antonio|last45=Nuñez|first45=Enrique Casal|title=Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)|journal=Scandinavian Journal of Gastroenterology|volume=46|issue=2|year=2010|pages=236–246|issn=0036-5521|doi=10.3109/00365521.2010.525794}}</ref><ref name="O’NeillElder2011">{{cite journal|last1=O’Neill|first1=Stephen|last2=Elder|first2=Kenny|last3=Harrison|first3=Sarah J.|last4=Yalamarthi|first4=Satheesh|title=Predictors of severity in ischaemic colitis|journal=International Journal of Colorectal Disease|volume=27|issue=2|year=2011|pages=187–191|issn=0179-1958|doi=10.1007/s00384-011-1301-x}}</ref>
+Ischemic colitis can be classified into the following types based on clinical features of disease:<ref name="pmid3045452">{{cite journal |vauthors=Hunter GC, Guernsey JM |title=Mesenteric ischemia |journal=Med. Clin. North Am. |volume=72 |issue=5 |pages=1091–115 |year=1988 |pmid=3045452 |doi= |url=}}</ref><ref name="NikolicKeck2017">{{cite journal|last1=Nikolic|first1=Amanda L.|last2=Keck|first2=James O.|title=Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management|journal=ANZ Journal of Surgery|year=2017|issn=14451433|doi=10.1111/ans.14237}}</ref><ref name="MontoroBrandt2010">{{cite journal|last1=Montoro|first1=Miguel A.|last2=Brandt|first2=Lawrence J.|last3=Santolaria|first3=Santos|last4=Gomollon|first4=Fernando|last5=Puértolas|first5=Belén Sánchez|last6=Vera|first6=Jesús|last7=Bujanda|first7=Luis.|last8=Cosme|first8=Angel|last9=Cabriada|first9=José Luis|last10=Durán|first10=Margarita|last11=Mata|first11=Laura|last12=Santamaría|first12=Ana|last13=Ceña|first13=Gloria|last14=Blas|first14=Jose Manuel|last15=Ponce|first15=Julio|last16=Ponce|first16=Marta|last17=Rodrigo|first17=Luis|last18=Ortiz|first18=Jacobo|last19=Muñoz|first19=Carmen|last20=Arozena|first20=Gloria|last21=Ginard|first21=Daniel|last22=López-Serrano|first22=Antonio|last23=Castro|first23=Manuel|last24=Sans|first24=Miquel|last25=Campo|first25=Rafael|last26=Casalots|first26=Alex|last27=Orive|first27=Víctor|last28=Loizate|first28=Alberto|last29=Titó|first29=Lluçia|last30=Portabella|first30=Eva|last31=Otazua|first31=Pedro|last32=Calvo|first32=M.|last33=Botella|first33=Maria Teresa|last34=Thomson|first34=Concepción|last35=Mundi|first35=Jose Luis|last36=Quintero|first36=Enrique|last37=Nicolás|first37=David|last38=Borda|first38=Fernando|last39=Martinez|first39=Benito|last40=Gisbert|first40=Javier P.|last41=Chaparro|first41=María|last42=Bernadó|first42=Alfredo Jimenez|last43=Gómez-Camacho|first43=Federico|last44=Cerezo|first44=Antonio|last45=Nuñez|first45=Enrique Casal|title=Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)|journal=Scandinavian Journal of Gastroenterology|volume=46|issue=2|year=2010|pages=236–246|issn=0036-5521|doi=10.3109/00365521.2010.525794}}</ref><ref name="O’NeillElder2011">{{cite journal|last1=O’Neill|first1=Stephen|last2=Elder|first2=Kenny|last3=Harrison|first3=Sarah J.|last4=Yalamarthi|first4=Satheesh|title=Predictors of severity in ischaemic colitis|journal=International Journal of Colorectal Disease|volume=27|issue=2|year=2011|pages=187–191|issn=0179-1958|doi=10.1007/s00384-011-1301-x}}</ref>
-* Reversible ischemic colopathy
+==== Reversible ischemic colopathy ====
-** This type is characterized by submucosal haemorrhage at endoscopy, with involvement of superficial mucosa.
+* Characterized by [[Submucosa|submucosal]] [[Bleeding|hemorrhage]] at [[endoscopy]], with involvement of [[Superficial (human anatomy)|superficial]] [[Mucous membrane|mucosa]]
-** It is typically self-limiting.
+* Self-limiting
-* Transient: the most common form
+==== Transient (most common form) ====
-** These patients present with abdominal pain, per-rectal bleeding and full-thickness involvement of the mucosa.
+* Present with [[abdominal pain]], [[rectal bleeding]] and full-thickness involvement of the [[Mucous membrane|mucosa]]
-* Chronic segmental or chronic ulcerative
+==== Chronic segmental or chronic ulcerative ====
-** These patients present with persistent symptoms or recurrent episodes of pain, per-rectal bleeding, diarrhoea, and segmental colitis on imaging.
+* Persistent symptoms or recurrent episodes of [[pain]], [[rectal bleeding]], [[diarrhea]], and segmental colitis on [[imaging]]
-** Resection is often curative.
+* [[Resection]] is usually curative
-* Ischaemic colonic stricture
+==== [[Ischemia|Ischemic]] colonic [[Stenosis|stricture]] ====
-** This may be detected acutely, however, more frequently is found at follow-up endoscopy.
+* Found at follow-up [[endoscopy]]
-* Gangrenous colitis
+==== [[Gangrene|Gangrenous]] colitis ====
-** This should be suspected when there is increasing abdominal pain, signs of local or generalized peritonitis, fevers or associated ileus.
+* Suspected when there is increasing [[abdominal pain]], [[Medical sign|signs]] of local or generalized [[peritonitis]], [[fever]] or [[ileus]]
-* Universal fulminant pancolitis
+==== Universal [[fulminant]] [[pancolitis]] ====
-** This presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon, resultant sepsis and perforation.
+* Presents acutely with severe symptoms, progressive transmural [[infarction]] and [[necrosis]] of the entire [[Colon (anatomy)|colon]]
-** 75% mortality rate.
+* Results in [[sepsis]] and [[perforation]]
-** These patients present with sepsis, severe abdominal pain, peritonitis and per-rectal bleeding.
+* 75% [[mortality rate]]
+* [[Symptom|Symptoms]] include [[sepsis]], severe [[abdominal pain]], [[peritonitis]] and [[rectal bleeding]]
+=== Percentage for each type: ===
 {|
 ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Classification of ischemic colitis by percentage
 |-
-! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Cancers
+! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Type
 ! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Percentage (%)
 |-
@@ Line 43: / Line 45: @@
 | style="background:#F5F5F5;" align="center" + |45
 |-
-| style="background:#DCDCDC;" align="center" + |Chronic segmental or ulcerative
+| style="background:#DCDCDC;" align="center" + |[[Chronic (medical)|Chronic]] segmental or ulcerative
 | style="background:#F5F5F5;" align="center" + |17.9-25
 |-
-| style="background:#DCDCDC;" align="center" + |Ischemic colonic stricture
+| style="background:#DCDCDC;" align="center" + |[[Ischemia|Ischemic]] colonic [[Stenosis|stricture]]
 | style="background:#F5F5F5;" align="center" + |10-15
 |-
-| style="background:#DCDCDC;" align="center" + |Gangrenous colitis
+| style="background:#DCDCDC;" align="center" + |[[Gangrene|Gangrenous]] colitis
 | style="background:#F5F5F5;" align="center" + |9.9-19
 |-
-| style="background:#DCDCDC;" align="center" + |Universal fulminant pancolitis
+| style="background:#DCDCDC;" align="center" + |Universal [[fulminant]] [[pancolitis]]
 | style="background:#F5F5F5;" align="center" + |1-2.5
 |}
-Ischemic colitis can be classified based on its clinical course into two types:
+Ischemic colitis can be classified into the following types based on clinical course of disease:
-*[[Acute]] ischemic colitis
-**Occlusive
-***Due to arterial or venous thrombosis blocking blood supply.
-**Non-Occlusive
-***Due to hypoperfusion of the colon.
-*[[Chronic]] ischemic colitis.
+==== [[Acute]] ischemic colitis ====
+*[[Thromboembolism|Occlusive]]
+**Due to [[Artery|arterial]] or [[Vein|venous]] [[thrombosis]] blocking [[blood]] supply
+*Non-Occlusive
+**Due to [[Shock|hypoperfusion]] of the [[Colon (anatomy)|colon]]
+==== [[Chronic]] ischemic colitis ====
 {{familytree/start|summary=Sample 1}}
 {{familytree | | | | | | | | A01 |A01=Ischemic colitis}}
@@ Line 74: / Line 77: @@
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
+[[Category:Gastroenterology]]
+[[Category:Medicine]]
+[[Category:Disease]]
+[[Category:Emergency medicine]]
+[[Category:Up-To-Date]]

Ischemic colitis classification: Difference between revisions

Latest revision as of 14:06, 5 February 2018

Overview

Classification

Reversible ischemic colopathy

Transient (most common form)

Chronic segmental or chronic ulcerative

Ischemic colonic stricture

Gangrenous colitis

Universal fulminant pancolitis

Percentage for each type:

Acute ischemic colitis

Chronic ischemic colitis

References

Navigation menu