Ischemic colitis medical therapy: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 8: | Line 8: | ||
===Intravenous Fluids=== | ===Intravenous Fluids=== | ||
[[Intravenous therapy|IV fluids]] are given to treat [[dehydration]], and the patient is placed on bowel rest (meaning nothing to eat or drink) until the symptoms resolve. | * [[Intravenous therapy|IV fluids]] are given to treat [[dehydration]], and the patient is placed on bowel rest (meaning nothing to eat or drink) until the symptoms resolve. | ||
===Optimize Cardiac Output=== | ===Optimize Cardiac Output=== | ||
If possible, cardiac function and oxygenation should be optimized to improve oxygen delivery to the ischemic bowel. | * If possible, cardiac function and oxygenation should be optimized to improve oxygen delivery to the ischemic bowel. | ||
===Nasogastric Tube=== | ===Nasogastric Tube=== | ||
A [[nasogastric tube]] may be inserted if an [[ileus]] is present. | * A [[nasogastric tube]] may be inserted if an [[ileus]] is present. | ||
===Antibiotics=== | ===Antibiotics=== | ||
[[Antibiotic]]s are sometimes given in moderate to severe cases | * [[Antibiotic]]s are sometimes given in moderate to severe cases. The data supporting this practice dates to the 1950s.<ref>PATH, EJ, McCLURE, JN Jr. Intestinal obstruction; the protective action of sulfasuxidine and sulfathalidine to the ileum following vascular damage. Ann Surg 1950; 131:159.</ref> More recent animal data suggests that antibiotics may increase survival and prevent [[bacteria]] from crossing the damaged lining of the colon into the bloodstream.<ref>{{cite journal | author = Plonka A, Schentag J, Messinger S, Adelman M, Francis K, Williams J | title = Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats. | journal = J Surg Res | volume = 46 | issue = 3 | pages = 216-20 | year = 1989 | id = PMID 2921861}}</ref><ref>{{cite journal | author = Bennion R, Wilson S, Williams R | title = Early portal anaerobic bacteremia in mesenteric ischemia. | journal = Arch Surg | volume = 119 | issue = 2 | pages = 151-5 | year = 1984 | id = PMID 6696611}}</ref><ref>{{cite journal | author = Redan J, Rush B, Lysz T, Smith S, Machiedo G | title = Organ distribution of gut-derived bacteria caused by bowel manipulation or ischemia. | journal = Am J Surg | volume = 159 | issue = 1 | pages = 85-9; discussion 89-90 | year = 1990 | id = PMID 2403765}}</ref> | ||
* The use of [[prophylactic]] antibiotics in ischemic colitis has not been prospectively evaluated in [[human]]s, but many authorities recommend their use based on the animal data.<ref>Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2334.</ref> | |||
====Contraindicated medications==== | ====Contraindicated medications==== | ||
Revision as of 14:34, 22 March 2017
|
Ischemic colitis Microchapters |
|
Case Studies |
|
Ischemic colitis medical therapy On the Web |
|
American Roentgen Ray Society Images of Ischemic colitis medical therapy |
|
Risk calculators and risk factors for Ischemic colitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Except in the most severe cases, ischemic colitis is treated with supportive care.
Medical Therapy
Intravenous Fluids
- IV fluids are given to treat dehydration, and the patient is placed on bowel rest (meaning nothing to eat or drink) until the symptoms resolve.
Optimize Cardiac Output
- If possible, cardiac function and oxygenation should be optimized to improve oxygen delivery to the ischemic bowel.
Nasogastric Tube
- A nasogastric tube may be inserted if an ileus is present.
Antibiotics
- Antibiotics are sometimes given in moderate to severe cases. The data supporting this practice dates to the 1950s.[1] More recent animal data suggests that antibiotics may increase survival and prevent bacteria from crossing the damaged lining of the colon into the bloodstream.[2][3][4]
- The use of prophylactic antibiotics in ischemic colitis has not been prospectively evaluated in humans, but many authorities recommend their use based on the animal data.[5]
Contraindicated medications
Ischemic colitis is considered an absolute contraindication to the use of the following medications:
References
- ↑ PATH, EJ, McCLURE, JN Jr. Intestinal obstruction; the protective action of sulfasuxidine and sulfathalidine to the ileum following vascular damage. Ann Surg 1950; 131:159.
- ↑ Plonka A, Schentag J, Messinger S, Adelman M, Francis K, Williams J (1989). "Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats". J Surg Res. 46 (3): 216–20. PMID 2921861.
- ↑ Bennion R, Wilson S, Williams R (1984). "Early portal anaerobic bacteremia in mesenteric ischemia". Arch Surg. 119 (2): 151–5. PMID 6696611.
- ↑ Redan J, Rush B, Lysz T, Smith S, Machiedo G (1990). "Organ distribution of gut-derived bacteria caused by bowel manipulation or ischemia". Am J Surg. 159 (1): 85–9, discussion 89-90. PMID 2403765.
- ↑ Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2334.