Ogilvie syndrome pathophysiology: Difference between revisions
| Line 12: | Line 12: | ||
In patients with acute colonic pseudo-obstruction, increasing colonic diameter accelerates the rise in tension on the colonic wall, increasing the risk of colonic ischemia and perforation. The risk of colonic perforation increases when cecal diameter exceeds 10 to 12 cm and when the distention has been present for greater than six days [12]. The duration of dilation is probably more important than the absolute diameter of the colon. | In patients with acute colonic pseudo-obstruction, increasing colonic diameter accelerates the rise in tension on the colonic wall, increasing the risk of colonic ischemia and perforation. The risk of colonic perforation increases when cecal diameter exceeds 10 to 12 cm and when the distention has been present for greater than six days [12]. The duration of dilation is probably more important than the absolute diameter of the colon. | ||
Rare cases have been reported in association with atrophic visceral myopathy with an extremely thin colonic wall, atrophic circular, and longitudinal muscularis propria without inflammation or fibrosis, and unaffected ganglion cells and myenteric plexus. The cause of the smooth muscle atrophy was unclear and the only potential association was with prior hypothyroidism. | Rare cases have been reported in association with atrophic visceral myopathy with an extremely thin colonic wall, atrophic circular, and longitudinal muscularis propria without inflammation or fibrosis, and unaffected ganglion cells and myenteric plexus. The cause of the smooth muscle atrophy was unclear and the only potential association was with prior hypothyroidism. | ||
====Ogilvie's syndrome==== | |||
*The association of [[Spinal anaesthesia|spinal anaesthesias]], drugs and nervous trauma has lead to the understanding that Ogilvie syndrome (colonic dilatation without pseudo-obstruction) may be caused by impairment of the autonomic nervous system.<ref name="pmid3753674">{{cite journal |vauthors=Vanek VW, Al-Salti M |title=Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases |journal=Dis. Colon Rectum |volume=29 |issue=3 |pages=203–10 |year=1986 |pmid=3753674 |doi= |url=}}</ref><ref name="pmid3319452">{{cite journal |vauthors=Ogilvie WH |title=William Heneage Ogilvie 1887-1971. Large-intestine colic due to sympathetic deprivation. A new clinical syndrome |journal=Dis. Colon Rectum |volume=30 |issue=12 |pages=984–7 |year=1987 |pmid=3319452 |doi= |url=}}</ref><ref name="pmid17643908">{{cite journal |vauthors=Saunders MD |title=Acute colonic pseudo-obstruction |journal=Best Pract Res Clin Gastroenterol |volume=21 |issue=4 |pages=671–87 |year=2007 |pmid=17643908 |doi=10.1016/j.bpg.2007.03.001 |url=}}</ref> | |||
*Damage to the [[Parasympathetic nervous system|parasympathetic]] fibers of S2 - S4 causes the distal colon to become atonic and become obstructed proximally. | |||
*However, the exact mechanism is unknown, especially in patients who present with this syndrome without an obvious injury to the parasympathetic nerves. | |||
*Acute colonic pseudo-obstruction occurs when the colon's diameter rises quickly, which increases the tension in the colonic wall, leading to colonic [[ischemia]] and possibly, [[perforation]] with a diameter exceeding 10 - 12cm. | |||
*A rare case of Ogilvie syndrome showed atrophic myopathy with a thinned out colonic wall, despite a perfectly intact [[myenteric plexus]] and unaffected [[Ganglion cell|ganglion cells]], with no evidence of [[fibrosis]] or [[inflammation]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Revision as of 01:30, 4 February 2018
Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.
| Ogilvie syndrome Microchapters
|
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Ogilvie syndrome pathophysiology On the Web |
|
American Roentgen Ray Society Images of Ogilvie syndrome pathophysiology |
|
Risk calculators and risk factors for Ogilvie syndrome pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Pathogenesis
The precise mechanism by which colonic dilation occurs in patients with acute colonic pseudo-obstruction is unknown. The association with trauma, spinal anesthesia, and pharmacologic agents suggests an impairment of the autonomic nervous system. Interruption of the parasympathetic fibers from S2 to S4 leaves an atonic distal colon and a functional proximal obstruction . However, there is no proposed mechanism to explain colonic dilation in those patients without obvious involvement of the parasympathetic nerves.
In patients with acute colonic pseudo-obstruction, increasing colonic diameter accelerates the rise in tension on the colonic wall, increasing the risk of colonic ischemia and perforation. The risk of colonic perforation increases when cecal diameter exceeds 10 to 12 cm and when the distention has been present for greater than six days [12]. The duration of dilation is probably more important than the absolute diameter of the colon.
Rare cases have been reported in association with atrophic visceral myopathy with an extremely thin colonic wall, atrophic circular, and longitudinal muscularis propria without inflammation or fibrosis, and unaffected ganglion cells and myenteric plexus. The cause of the smooth muscle atrophy was unclear and the only potential association was with prior hypothyroidism.
Ogilvie's syndrome
- The association of spinal anaesthesias, drugs and nervous trauma has lead to the understanding that Ogilvie syndrome (colonic dilatation without pseudo-obstruction) may be caused by impairment of the autonomic nervous system.[1][2][3]
- Damage to the parasympathetic fibers of S2 - S4 causes the distal colon to become atonic and become obstructed proximally.
- However, the exact mechanism is unknown, especially in patients who present with this syndrome without an obvious injury to the parasympathetic nerves.
- Acute colonic pseudo-obstruction occurs when the colon's diameter rises quickly, which increases the tension in the colonic wall, leading to colonic ischemia and possibly, perforation with a diameter exceeding 10 - 12cm.
- A rare case of Ogilvie syndrome showed atrophic myopathy with a thinned out colonic wall, despite a perfectly intact myenteric plexus and unaffected ganglion cells, with no evidence of fibrosis or inflammation.
References
- ↑ Vanek VW, Al-Salti M (1986). "Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases". Dis. Colon Rectum. 29 (3): 203–10. PMID 3753674.
- ↑ Ogilvie WH (1987). "William Heneage Ogilvie 1887-1971. Large-intestine colic due to sympathetic deprivation. A new clinical syndrome". Dis. Colon Rectum. 30 (12): 984–7. PMID 3319452.
- ↑ Saunders MD (2007). "Acute colonic pseudo-obstruction". Best Pract Res Clin Gastroenterol. 21 (4): 671–87. doi:10.1016/j.bpg.2007.03.001. PMID 17643908.