Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow.
in this presentation me & my colleagues discuss briefly the types of mesenteric ischemia ( acute , chronic , venous ) and its related syndromes (superior mesenteric artery syndrome , celiac trunk syndrome and supply it by good radiologic images ..
Information about Ischemic Colitis by Dr. Dhaval Mangukiya.
Details of Ischaemic colitis, Colonic circulation, CT diagnosis of colonic ischemic, Management of colonic ischaemia, Dignosis of colonic ischaemia, Colours of ischaemia, cleveland clinic guidelines, Indications for surgery in colonic ischaemia, Surgery for colonic ischaemia, Outcome of ischaemic colitis.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
in this presentation me & my colleagues discuss briefly the types of mesenteric ischemia ( acute , chronic , venous ) and its related syndromes (superior mesenteric artery syndrome , celiac trunk syndrome and supply it by good radiologic images ..
Information about Ischemic Colitis by Dr. Dhaval Mangukiya.
Details of Ischaemic colitis, Colonic circulation, CT diagnosis of colonic ischemic, Management of colonic ischaemia, Dignosis of colonic ischaemia, Colours of ischaemia, cleveland clinic guidelines, Indications for surgery in colonic ischaemia, Surgery for colonic ischaemia, Outcome of ischaemic colitis.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This is a presentation detailing facts about abdominal tuberculosis. Intended for healthcare professionals and medical students
Dr Manoj K Ghoda
Gujarat Gastro Group
Tuberculosis can affect any organ system, particularly in immunocompromised individuals Defined as tuberculosis infection of the abdomen involving the peritoneum and its reflections, gastrointestinal tract, abdominal lymphatics and solid visceral organs.
Often reveals a mass made up of matted loops of small bowel with thickened walls, diseased omentum, mesentery and loculated ascites
Regional lymph nodal enlargement
Extrapulmonary TB
This is a presentation detailing facts about abdominal tuberculosis. Intended for healthcare professionals and medical students
Dr Manoj K Ghoda
Gujarat Gastro Group
Tuberculosis can affect any organ system, particularly in immunocompromised individuals Defined as tuberculosis infection of the abdomen involving the peritoneum and its reflections, gastrointestinal tract, abdominal lymphatics and solid visceral organs.
Often reveals a mass made up of matted loops of small bowel with thickened walls, diseased omentum, mesentery and loculated ascites
Regional lymph nodal enlargement
Extrapulmonary TB
Cимптоматология заболеваний толстой и тонкой кишкиСлава Коломак
Заболевания органов пищеварения имеют широкое распространение, в связи с чем бесспорно их социальное значение.
Понимание темы развивает ответственность будущего врача за своевременную диагностику заболеваний органов пищеварения, особенно онкологических заболеваний желудочно-кишечного тракта
GEMC: Mesenteric Ischemia: Resident Training Open.Michigan
This is a lecture by Dr. Andrew Barnosky from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Describe types of bowel wall thickening on enhanced CT scan and the diagnostic signs to differentiate inflammatory , neoplastic , ischemic and other causes of bowel wall thickening .
Vascular disease is a condition that develops when the arteries that supply the intestines with blood become narrowed due to the build-up of plaque. This results in a lack of blood supply to the intestines.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
4. Ischaemic colitis refers to inflammation of the colon
secondary to vascular insufficiency and ischaemia. It is
sometimes considered under the same spectrum
of intestinal ischaemia. The severity and consequences
of the disease are highly variable.
Ischemic colitis encompasses a number of clinical
entities, all with an end result of insufficient blood
supply to a segment or the entire colon.
5. Ischemic colitis is the most common form of
gastrointestinal (GI) ischemia, accounting for 50 to
60% of all cases and occurring with an incidence of
4.5 to 44 cases per 100,000 person years.
It accounts for 1 in 2000 hospital admissions. The
causes of ischemic colitis are numerous, but all
lead to diminished perfusion of the colon, which in
turn leads to mucosal injury or even full-thickness
necrosis.
9. The SMA and IMA communicate through the Marginal Artery
of ‘Drummond’, runs in the mesentery close to the bowel
along the splenic flexure.
Points of communication between collateral arteries
are at higher risk for ischemia
These points are:
the splenic flexure
the recto sigmoid junction
However any segment of the colon may be
involved.
10. WATERSHED AREAS
Areas that are prone to Ischemia during
hypoperfusion & these areas lack in Anastomosis or
they have small amount of blood flow.
(1) the splenic flexure
(called as Griffitt’s Point)
between the SMA and IMA blood supply
(2) the distal sigmoid colon
(called as Sudek’s Point)
between the IMA and hypogastric artery supply
Limited collateral networks and are more
vulnerable to low flow states
11.
12. Right Vs. Left
• The vasa recta are smaller and less
developed in the right colon
• These vessels are sensitive to
vasospasm
This explains the susceptibility of the
right colon to ischemia
14. Colonic blood supply
The colon receives blood from both the superior and
inferior mesenteric arteries.
The blood supply from these two major arteries overlap
with abundant collateral circulation.
There are vascular “weak” points, at the borders of the
territory supplied by each of these arteries.
These watershed areas are most vulnerable to ischemia
when blood flow decreases, as they have the fewest
vascular collaterals.
The rectum receives blood from both the inferior
mesenteric artery and the internal iliac arteries.
The rectum is rarely involved with colonic ischemia due
to this dual blood supply.
15. Development of ischemia—
Under ordinary conditions, the colon receives between
10% and 35% of the total cardiac output.
If blood flow to the colon drops by more than about
50%, ischemia will develop.
The arteries feeding the colon are very sensitive to
vasoconstrictors.
As a result, during periods of low blood pressure, the
arteries feeding the colon clamp down vigorously.
A similar process can result from vasoconstricting drugs
such as ergotamine, cocaine, or vasopressors.
This vasoconstriction can result in non-occlusive
ischemic colitis.
16. Different pathological outcomes include :
gangrenous (15-20%)
non-gangrenous (80-85%):
reversible
non-reversible
(chronic colitis, stricture formation)
17. The majority of patients (85%) develop non-gangrenous
ischemia, which is usually transient and resolves without
sequelae. Only a minority of these patients develop
long-term complications, which include persistent
segmental colitis and the development of a stricture.
Approximately 15% of patients with colonic ischemia
develop gangrene, the consequences of which are life-
threatening sepsis, bowel infarction, and death.
Reversible colopathy
Transient colitis
Chronic colitis
Stricture
Gangrene
Fulminant universal colitis
25. Others
Long distance running
Dialysis
Neurogenic
Spontaneous in young adults
Infections (CMV, E. coli O157:H7)
Airplane flight
26. RISK FACTORS
Suspect for Ischemic Colitis if:
Older than 60
Hemodialysis
Hypertension
Hypoalbuminemia
Diabetes Mellitus
Constipation-induced Medications
The presence 4 or more risk factors was 100% predictive
of Ischemic Colitis.
(Park CJ et al,2007)
28. SIGNS & SYMPTOMS
Three progressive phases of Ischemic Colitis have been
described:
A Hyperactive Phase occurs first in which the primary
symptoms are severe abdominal pain & the passage of
bloody stools. Many patients get better & do not progress
beyond this phase.
A Paralytic Phase if ischemia continues. In this phase the
abdominal pain becomes more widespread, the belly
becomes more tender to the touch & the bowel motility
decreases resulting in abdominal bloating, no further bloody
stools & absent bowel sounds on exam.
Finally, a Shock Phase can develop as fluids start to leak
through the damaged colon lining. This can result in shock &
metabolic acidosis with dehydration & low blood pressure,
rapid heart rate & confusion.
30. • Regardless of the mechanism, the
disease follows the same course.
• Depending on the cause and severity,
the morphologic pattern can be
divided into 3 groups:
31. 1. Transient Ischemia
Mucosal infarction in which ischemic damage is
confined to the mucosa
2. Partial thickness ischemia
Mural infarction in which the injury extends from
the mucosa into the muscularis mucosa
3. Full thickness infarction
Transmural infarction
32. • Transient Ischemia/ Partial Thickness
Result of hypoperfusion rather than occlusive
disease.
May involve any part of the gut and is usually
patchy and segmental.
• Full thickness
Result of thrombosis or embolism of SMA
More common in the small bowel, dependent on
the mesenteric blood supply.
Usually involves a long segment of bowel, tends
to occur in the 2 watershed territories.
34. LABS
Labs will be Normal in mild cases
Severe ischemia or necrosis may
produce:
- leukocytosis,
-metabolic acidosis,
-or an elevated lactate.
35. ABDOMINAL X RAY
Abdominal radiographs are often normal, but signs
include:
dilatation due to ileus
'thumbprinting' due to mucosal
oedema/haemorrhage
localised intramural gas (pneumatosis coli) if
necrotic
free intraperitoneal gas if perforated
38. BARIUM ENEMA
Contrast enema is abnormal in 90% but is rarely
used for diagnostic purposes:
segmental region of abnormality
'thumbprinting' which is classically obliterated by air
insufflation
spasm
ulcerations 'serated mucosa'
stricture from fibrosis as a late complication of
ischaemia
44. ERECT RADIOGRAPH OBTAINED AFTER A DOUBLE-CONTRAST BARIUM ENEMA STUDY SHOWS A
STRICTURE AT THE SPLENIC FLEXURE.
45. CT
Contrast enhanced imaging is the modality of choice. Features
include:
segmental region of abnormality
symmetrical or lobulated thickening of bowel wall
irregularly narrowed lumen
submucosal oedema may produce low-density ring bordering
lumen (target sign)
Irregular narrowing of the bowel lumen as a result of mucosal
edema (thumbprinting)
intramural or portal venous gas
mesenteric oedema
superior mesenteric artery or vein thrombus/occlusion may be
demonstrated
Nonspecific signs of bowel ischemia, including bowel
obstruction, mesenteric edema and ascites
49. CONTRAST-ENHANCED CT IN PATIENTS WITH ACUTE OCCLUSIVE IC: HOMOGENEOUS LEFT COLONIC
INVOLVEMENT WITH DISAPPEARANCE OF THE LUMEN (ARROW) AND HYPERPERFUSION OF THE
MUCOSA IN CORONAL PLANE.
50. PATIENT WITH EMBOLIC IMA OCCLUSION IN ACUTE PHASE:
LEFT COLONIC WALL THICKENING (WHITE ARROW) WITH EVIDENCE OF “LITTLE
ROSE” SIGN OR TARGET ASPECT, PERICOLIC FLUID WAS ALSO PRESENT (CURVED ARROW)
51. AIR-CONTAINING, CYSTIC LUCENCIES ARE SEEN IN BOWEL WALL IN PROXIMAL DESCENDING
COLON (WHITE CIRCLE) AND IN THE WALL OF
THE LARGE BOWEL IN THE LOWER ABDOMEN (BLACK ARROWS).
53. MRI
Sensitivity of MRI in the detection of bowel
ischemia is comparable to that of CT
MRI may be useful in depicting bowel-wall changes
and in demonstrating mesenteric vascular
abnormalities.
As with CT, the additional use of contrast
enhancement allows an assessment of the dynamic
changes in the bowel wall.
54. ULTRASONOGRAPHY
Bowel gas frequently prevents the visualization of
colonic changes, which are usually most marked
around the splenic flexure.
The bowel wall becomes thickened, and nodular
and intramural hemorrhage and edema give rise to
areas of reduced echogenicity.
Echogenic areas may be seen in the bowel wall;
these may reflect either areas of infarction infiltrate
or clot.
58. COLOR DOPPLER USG
Color flow Doppler sonography is effective in
demonstrating flow disturbances associated with
tortuosity and stenosis at the origin of the celiac
axis.
59. NONSTRATIFIED THICKENING OF BOWEL WALL OF DESCENDING AND SIGMOID COLONS (S) AND ALTERED PERICOLIC
FAT (WHITE ARROWS). BARELY VISIBLE COLOR DOPPLER FLOW (ONLY ONE COLOR PIXEL) IS SEEN (BLACK ARROW).
ALSO NOTE VASCULAR ENGORGEMENT (ARROWHEADS).
60. ANGIOGRAPHY
Angiography has a limited role in the diagnosis of
colonic ischemia, in most cases colonic blood flow
has already returned to normal by the time of
symptom onset.
However, angiography may be indicated if the
clinical examination and other studies can not
exclude small bowel ischemia due to acute
proximal mesentric thrombus or embolus
Can show mesenteric artery occlusion if present.
61.
62.
63.
64.
65.
66. INFERIOR MESENTERIC ANGIOGRAM SHOWS A STENOSIS OF MORE THAN 50% AT THE ORIGIN OF
THE LEFT COLIC ARTERY ASSOCIATED WITH A POSTSTENOTIC DILATATION
67. NUCLEAR MEDICINE
Increased uptake of Tc99m (V) DMSA (pentavalent
techenetium-99m dimercaptosuccinic acid) tracer in
the ischaemic bowel may be present but is
unreliable.
68. COLONOSCOPY
The procedure of choice if the diagnosis remains
unclear
Findings at colonoscopy depend on the stage and
severity of ischemia.
- Early stages of ischemia, petechial hemorrhages
are interspersed with areas of pale, edematous
mucosa.
- Later, segmental erythema, +/-ulcerations and
bleeding
Colonoscopy is preferable to contrast enemas since it is
more sensitive in detecting mucosal lesions, permits
biopsies to be obtained, and does not interfere with
subsequent angiography.
70. Ischemic colitis usually gets better on its own
within two to three days. In more-severe cases,
complications can include:
Tissue death (gangrene) resulting from
diminished blood flow
Hole (perforation) in intestine or persistent
bleeding
Bowel inflammation (segmented ulcerating
colitis)
Bowel obstruction (ischemic stricture)
72. Imaging differential considerations include:
other colitides
o ulcerative colitis
o Crohn colitis
o infective colitis: pseudomembranous, amebiasis,
schistosomiasis
o radiation colitis
intramural haemorrhage
diverticulitis
lymphoma or carcinoma
73. The features considered atypical in
inflammatory bowel diseases , such as
1. segmental distribution of the disease,
infrequent rectal involvement,
2. high rate of spontaneous recovery,
low rate of recurrence,
3. lack of adequate response to usual inflammatory
bowel disease therapy,
4. frequent progression to fibrotic stenosis with
delayed obstruction
The features above are now recognized as
characteristic of colonic ischemia.
74. CLINICALLY
Ulcerative colitis
Bloody diarrhea
Crohn’s colitis
Perianal lesions common; frank bleeding less
frequent than in ulcerative colitis
Ischemic Colitis
Older age groups; vascular disease; sudden
onset, often painful
77. Treatment of the patient is dictated by the
severity of the ischemia .
78. 1. Transient Ischemia
Treated symptomatically
Observation with :
Bowel rest, IVF, O2 and optomise cardiac function
2. Partial thickness ischemia
Close observation, IVF, broad-spectrum antibiotics
If stricture develops and is symptomatic, resection
may be required.
3. Full thickness infarction
Surgical resection
79. Full thickness/Gangrenous infarction
• Approximately 20% of patients with IC will
require surgery because of peritonitis or
clinical deterioration despite conservative
management
• Emergency resection of non viable bowel is
required and colostomy is usually done.
81. Always consider the diagnosis of ischemic colitis
whenever contemplating the diagnosis of
inflammatory bowel disease in the elderly.
Thumbprinting of the colon on plain abdominal
radiographs suggests ischemic colitis.
CT with oral & IV contrast is the imaging modality of
choice to assess distribution & phase of Colitis
82. Finding on CT or MRI (e.g., bowel wall thickening,
edema, thumbprinting, pericolonic fat stranding) are
suggestive of IC, but not specific for diagnosis
CT (MRI) findings of colonic pneumatosis & porto-
mesentric venous gas are highly suggestive of
transmural colonic infarction, but not dignostic
Common findings (good prognosis) are non-specific
& more specific findings (bad prognosis) are
Uncommon
83. Evaluation is by CT & Colonoscopy not
Angiography
CT scan is the initial screening test; may help determine
prognosis
Colonoscopy is the test of choice for confirming
diagnosis; may help determine prognosis
Antibiotics for moderate to severe Ischemic Colitis
Surgical consultation is warranted in all cases of
suspected Ischemic Colitis.