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Ischemic Colitis

Definition


Disease: Ischemic Colitis Ischemic Colitis
Category: Digestive diseases
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Disease Definition:

The condition in which part of the colon (large intestine) becomes inflamed and injured is known as ischemic colitis. The problem results from impaired flow to the colon. This can contribute to areas of colon inflammation and, in certain cases, irreversible colon damage.

Any part of the colon can be affected by ischemic colitis, although most affected people develop pain on the left side of the abdomen. Urgent bowel movements and bloody diarrhea are additionally common to ischemic colitis.

Most cases of ischemic colitis are mild and resolve on their own in a couple of days. Yet, consulting a doctor immediately when experiencing symptoms of ischemic colitis would be wise due to the possibility of the condition becoming severe.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The following are signs and symptoms of ischemic colitis:

 

  • Low-grade fever
  • Diarrhea
  • Vomiting
  • Abdominal pain, cramping or tenderness, often localized to the lower left side of the abdomen; the onset can either be abrupt or gradual
  • A feeling of urgency to move bowels
  • Bright red or maroon-colored blood in the stool or passage of blood without stool at times.
  • Nausea

 

As signs and symptoms affect the right side of the abdomen, the risk of severe complications resulting from ischemic colitis increases.
The arteries feeding the right side of the colon can additionally feed part of the small intestine. When blood is prevented from flowing on the right side of the colon, it’s likely that part of the small intestine isn’t receiving adequate blood supply as well. Additional signs and symptoms of problems in the small intestine involve pain in the upper abdomen that comes in after eating and is severe enough to result in avoiding food and weight loss.
Death of intestinal tissue (infarction of necrosis) may quickly result from prevention of blood flow to the small intestine. Surgery will be required to clear the blockage and remove the part of the intestine that has died when this life-threatening situation occurs.
In the case of developing signs and symptoms of ischemic colitis, like bloody diarrhea and abdominal pain, consulting a doctor would be wise. Early diagnosis and treatment can help keep serious complications from this condition.

Causes:

Inadequate blood supply reaching the colon is involved. The most frequent cause in acute cases is blood clots in the arteries leading to colon. Chronic cases are often related to the accumulation of fatty deposits (atherosclerosis) in the blood vessels leading to the colon.
Ischemic colitis may either be resulting from or linked to other medical conditions such as the following in certain people:

 

 

  • Elevated sugar, or glucose, levels in the blood (diabetes mellitus)
  • Colon cancer
  • Radiation treatment to the abdomen
  • Protrusion of an organ or tissue into the surrounding tissue, interfering with the arterial as well as the venous blood supply to the intestine (hernia)
  • Inflammation of the blood vessels (vasculitis)
  • Easy blood clotting (hypercoagulable state)


The Role of Medications
Ischemic colitis may seldom result from certain medicines as a side effect. Such as:

 

  • Migraine medications in the triptan or ergot class
  • The heart drug digoxin
  • Nonsteroidal anti-inflammatory drugs
  • Blood pressure pills
  • Estrogen replacement medications
  • Pseudoephedrine
  • Certain antipsychotic drugs

 

The prescription drug alosetron, used by women suffering from severe irritable bowel syndrome (IBS) carries a Food and Drug Administration warning about its potential link to serious conditions, such as ischemic colitis. Reading a guide about this drug and signing an agreement indicating that one understands its risks and possible benefits may be required before starting to take it.
Other Causes
Sometimes abdominal surgery is followed by ischemic colitis, especially when it involves repair of a bulging arterial wall (aneurysm) in the region. Ishcemic colitis may sometimes be triggered by infections involving bacteria (such as Escherichia coli), parasites (Entamoeba histolytica) or viruses (cytomegalovirus).
The following are risk aspects for ischemic colitis:


Age: The condition occurs with greatest frequency in older adults. It may be a sign of a blood-clotting abnormality or an inflammation of the blood vessels (vasculitis) when it occurs in a young adult.
Heart Disease Risk Factors: The impaired blood flow responsible for ischemic colitis is more probable to occur in people suffering from traits or conditions commonly related to heart disease. These include high blood pressure, elevated cholesterol, triglyceride levels and tobacco use.
Certain Medical Conditions: Certain disorders are considered predisposing aspects that position the person at a higher risk of developing ischemic colitis, or they can aggravate it when it occurs. Heart failure, shock, low blood pressure and previous abdominal operations are included.

Complications

Complications:

Ischemic colitis mostly resolves on its own within 1 to 2 days. In more advanced cases of ischemic colitis, the following complications may result:


Gangrene: Tissue death in the colon (gangrene) may result from ischemic colitis when it isn’t promptly treated. Gangrene may develop three to four weeks after the initial impairment of blood flow to the colon and can cause death when one hasn’t received timely treatment.
Bleeding: A hole (perforation) in the intestine or persistent bleeding may result from ischemic colitis.
Pain and Blockage: Ischemic colitis can contribute to colon scarring and narrowing even when healing occurs. This can result in chronic abdominal pain and blockage.
Colon Cancer: Ischemic colitis is the first sign of colon cancer in rare cases.
Other Rare Complications: These may include the buildup of pus in the colon (abscess) and an inflammation of the membrane of the abdominal wall (peritonitis).

Treatments:

Depending on the severity of the condition, which treatment is best for ischemic colitis can be determined.
Medications may be prescribed to keep the blood pressure at normal levels when ischemic colitis is mild, to help ease blood flow to the colon. Antibiotic use may additionally be necessary in order to keep infections from developing. Any underlying health problems will be treated by the doctor, like heart failure, prescribing an aspirin a day.
Symptoms usually diminish in 24 to 48 hours in mild cases with such conservative measures without the need for hospitalization.
Hospitalization may be required yet, when one’s dehydrated to provide fluids and nutrients through the veins (intravenously). Restrictions on food intake may be required for a few days to let the intestines rest.
The doctor will go on monitoring the affected person on a regular basis, with follow-up colonoscopies to determine whether the disease has healed or progressed, and whether complications have developed. Healing may occur in two weeks or less in mild cases. Recovery can take longer in more severe cases and relapses can occur.
In case one develops ischemic colitis before the age of 50 or have a history of blood clots, one could have a disorder increasing the tendency of the blood to clot. A blood thinner will be used in such a case to treat the condition, such as warfarin that could help keep the likelihood of future ischemic colitis episodes from taking place.
Surgery


Certain people suffering from severe or prolonged ischemic colitis need surgical treatment to remove (resect) the affected part of the colon or bowel.
Surgery may be required for ischemic colitis when the condition is related to the following:

 

 

  • Bleeding ulcers.
  • Gangrene and blood infection (sepsis). Treatment for this severe complication additionally includes broad-spectrum antibiotics and blood replacement
  • Abdominal tenderness and fever that are severe and persistent, even after initial treatment with fluids and medications.
  • A hole (perforation) in the colon.

Prognosis:

Not Available

Expert's opinion

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