Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

876 Ischemic Bowel Disease

➣Pancreatitis – CT helpful

➣Inflammatory bowel disease – sigmoidoscopy/colonoscopy

important to make distinction – NOTE: rectum usually

involved in ulcerative colitis but rarely so in ischemia.

■If any question about diagnosis – early surgery is essential – time is

of the essence.

management

What to Do First

■Resuscitate quickly

■CT early in work-up-IV, oral and rectal contrast essential

General Measures

■Consult GI and Surgery quickly (limited colonoscopy may be helpful)

■Always have index of suspicion for ischemic bowel disease when pain

is “out of proportion” to the physical findings

■when in doubt – exploratory laparotomy or laparoscopy

specific therapy

■For severe ischemia with likely dead bowel – urgent surgery

■For intestinal angina – evaluate by elective angiography and consider

vascular reconstruction, angioplasty, stent, etc.

■For ischemic colitis – consider cardiology evaluation detect occult

may be helpful to look CHF, arrhythmias or valvular disease

■Elective angiography for treatable stenosis

follow-up

■When self-limited ischemic bowel subsides, evaluate for ASCVD,

coagulopathy, valvular heart disease, arrhythmias, occult CHF

■Small bowel ischemia with resection, common cause of chronic mal-

absorbtion “short gut syndrome” – may need TPN or supplements

complications and prognosis

■Major problem is missed diagnosis with subsequent dead bowel and

patient death

■“Short gut” syndrome with malabsorption common following exten-

sive small bowel resections

■If etiology not discovered and corrected, recurrent episodes common

often leading to a fatal outcome