Ischemic colitis other diagnostic studies: Difference between revisions
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==Overview== | ==Overview== | ||
Among patients with a suspicion of ischemic colitis, [[Endoscopy|endoscopic]] evaluation, via [[colonoscopy]] or flexible [[sigmoidoscopy]], is the diagnostic procedure of choice if the diagnosis remains unclear after other imaging studies. Colonoscopy is sensitive and allows visualization of colonic mucosa and histological analysis of biopsies. | Among patients with a suspicion of ischemic colitis, [[Endoscopy|endoscopic]] evaluation, via [[colonoscopy]] or [[Flexible sigmoidoscopy|flexible]] [[sigmoidoscopy]], is the [[Diagnosis|diagnostic]] procedure of choice if the [[diagnosis]] remains unclear after other [[imaging]] studies. [[Colonoscopy]] is sensitive and allows visualization of colonic [[Mucous membrane|mucosa]] and histological analysis of biopsies. [[Colonoscopy]] requires to be performed within 48 hours for [[diagnosis]] of ischemic colitis. | ||
==Endoscopy== | ==Endoscopy== | ||
* Ischemic colitis has a distinctive endoscopic appearance; endoscopy can also facilitate alternate diagnoses such as [[infection]] or [[inflammatory bowel disease]]. [[biopsy|Biopsies]] can be taken via endoscopy to provide more information.<ref name="MacDonald2002">{{cite journal|last1=MacDonald|first1=P.H.|title=Ischaemic colitis|journal=Best Practice & Research Clinical Gastroenterology|volume=16|issue=1|year=2002|pages=51–61|issn=15216918|doi=10.1053/bega.2001.0265}}</ref><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> | The [[endoscopy]] results for ischemic colitis are as follows: | ||
* Ischemic colitis has a distinctive [[Endoscopy|endoscopic]] appearance; [[endoscopy]] can also facilitate alternate [[Diagnosis|diagnoses]] such as [[infection]] or [[inflammatory bowel disease]]. | |||
* [[biopsy|Biopsies]] can be taken via [[endoscopy]] to provide more information.<ref name="MacDonald2002">{{cite journal|last1=MacDonald|first1=P.H.|title=Ischaemic colitis|journal=Best Practice & Research Clinical Gastroenterology|volume=16|issue=1|year=2002|pages=51–61|issn=15216918|doi=10.1053/bega.2001.0265}}</ref><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> | |||
*Early endoscopy can confirm the diagnosis and provides prognostic information. | *Early [[endoscopy]] can confirm the diagnosis and provides prognostic information. | ||
**Distinguishes between cases that need conservative management versus those that require emergency resection. | **Distinguishes between cases that need conservative management versus those that require [[emergency]] resection. | ||
* Transient non-gangrenous features of ischemic colitis observed at colonoscopy include: | * Transient non-gangrenous features of ischemic colitis observed at [[colonoscopy]] include: | ||
** Petechial | ** [[Petechia|Petechial hemorrhages]] | ||
** Edematous and fragile mucosa | ** Edematous and fragile [[Mucous membrane|mucosa]] | ||
**Segmental erythema | **Segmental [[erythema]] | ||
**Scattered erosions | **Scattered erosions | ||
**Longitudinal ulcerations (colon single stripe sign) | **Longitudinal [[Ulcer|ulcerations]] (colon single stripe sign) | ||
**A sharply defined segment of involvement | **A sharply defined segment of involvement | ||
*Transmural ischemia will show: | *Transmural [[ischemia]] will show: | ||
**Cyanosis and pseudo-polyps | **[[Cyanosis]] and pseudo-[[Polyp|polyps]] | ||
{{#ev:youtube|uHBUnFD-FBM}} | {{#ev:youtube|uHBUnFD-FBM}} | ||
==Colonoscopy== | ==Colonoscopy== | ||
* Colonoscopy findings for 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 name="WashingtonCarmichael2012">{{cite journal|last1=Washington|first1=Christopher|last2=Carmichael|first2=Joseph|title=Management of Ischemic Colitis|journal=Clinics in Colon and Rectal Surgery|volume=25|issue=04|year=2012|pages=228–235|issn=1531-0043|doi=10.1055/s-0032-1329534}}</ref> | * [[Colonoscopy]] findings for 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 name="WashingtonCarmichael2012">{{cite journal|last1=Washington|first1=Christopher|last2=Carmichael|first2=Joseph|title=Management of Ischemic Colitis|journal=Clinics in Colon and Rectal Surgery|volume=25|issue=04|year=2012|pages=228–235|issn=1531-0043|doi=10.1055/s-0032-1329534}}</ref> | ||
** Colonoscopy is sensitive and allows visualization of colonic mucosa and histological analysis of biopsies. | ** [[Colonoscopy]] is sensitive and allows visualization of colonic [[Mucous membrane|mucosa]] and [[Histology|histological]] analysis of [[Biopsy|biopsies]]. | ||
** Diagnosis requires colonoscopy within 48 hours. | ** [[Diagnosis]] requires [[colonoscopy]] within 48 hours. | ||
** Serial studies in connection with the clinical setting are necessary to establish the diagnosis. | ** Serial studies in connection with the clinical setting are necessary to establish the [[diagnosis]]. | ||
** Performed with limited insufflation to avoid over distension of the colon. | ** Performed with limited [[insufflation]] to avoid over [[distension]] of the [[Colon (anatomy)|colon]]. | ||
** Could lead to further ischemia or perforation. | ** Could lead to further [[ischemia]] or [[perforation]]. | ||
** | ** CO2 [[insufflation]] rather than air should be used. | ||
*** CO2 is rapidly absorbed and acts as a vasodilator. | *** CO2 is rapidly absorbed and acts as a [[vasodilator]]. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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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
Among patients with a suspicion of ischemic colitis, endoscopic evaluation, via colonoscopy or flexible sigmoidoscopy, is the diagnostic procedure of choice if the diagnosis remains unclear after other imaging studies. Colonoscopy is sensitive and allows visualization of colonic mucosa and histological analysis of biopsies. Colonoscopy requires to be performed within 48 hours for diagnosis of ischemic colitis.
Endoscopy
The endoscopy results for ischemic colitis are as follows:
- Ischemic colitis has a distinctive endoscopic appearance; endoscopy can also facilitate alternate diagnoses such as infection or inflammatory bowel disease.
- Biopsies can be taken via endoscopy to provide more information.[1][2]
- Early endoscopy can confirm the diagnosis and provides prognostic information.
- Distinguishes between cases that need conservative management versus those that require emergency resection.
- Transient non-gangrenous features of ischemic colitis observed at colonoscopy include:
- Petechial hemorrhages
- Edematous and fragile mucosa
- Segmental erythema
- Scattered erosions
- Longitudinal ulcerations (colon single stripe sign)
- A sharply defined segment of involvement
{{#ev:youtube|uHBUnFD-FBM}}
Colonoscopy
- Colonoscopy findings for ischemic colitis are as follows:[2][3]
- Colonoscopy is sensitive and allows visualization of colonic mucosa and histological analysis of biopsies.
- Diagnosis requires colonoscopy within 48 hours.
- Serial studies in connection with the clinical setting are necessary to establish the diagnosis.
- Performed with limited insufflation to avoid over distension of the colon.
- Could lead to further ischemia or perforation.
- CO2 insufflation rather than air should be used.
- CO2 is rapidly absorbed and acts as a vasodilator.
References
- ↑ MacDonald, P.H. (2002). "Ischaemic colitis". Best Practice & Research Clinical Gastroenterology. 16 (1): 51–61. doi:10.1053/bega.2001.0265. ISSN 1521-6918.
- ↑ 2.0 2.1 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.
- ↑ Washington, Christopher; Carmichael, Joseph (2012). "Management of Ischemic Colitis". Clinics in Colon and Rectal Surgery. 25 (04): 228–235. doi:10.1055/s-0032-1329534. ISSN 1531-0043.