Ischemic colitis medical therapy: Difference between revisions
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{{Ischemic colitis}} | {{Ischemic colitis}} | ||
{{CMG}}; {{AOEIC}} {{CZ}} | {{CMG}}; {{AOEIC}} {{CZ}} | ||
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==Overview== | ==Overview== | ||
Except in the most severe cases, ischemic colitis is treated with supportive care. | Except in the most severe cases, ischemic colitis is treated with supportive care. | ||
==Medical Therapy== | |||
==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; the data supporting this practice date 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> although there is more recent animal data suggesting 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> | [[Antibiotic]]s are sometimes given in moderate to severe cases; the data supporting this practice date 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> although there is more recent animal data suggesting 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> | ||
==References== | ==References== | ||
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Revision as of 00:31, 4 February 2013
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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 date to the 1950s,[1] although there is more recent animal data suggesting 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]
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.