Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ischemic colitis has been previously described in three forms: transient, strictured, and gangrenous. A fourth form of presentation in the elderly is characterized by signs of an acute abdomen, massive colonic dilatation, and systemic toxicity. Bloody diarrhea may be seen prior to the onset of dilatation. Ischemia should be considered as an etiologic factor in "colitis" in the elderly patient with segmental dilatation particularly if it follows a "low flow state." The rectum is usually uninvolved. Barium enema may confirm segmental involvement and later demonstrate stricture. Three patients with ischemic megacolon are presented. The diagnosis was suspected preoperatively in only one. In contrast to ulcerative colitis, these patients show a more abrupt onset and run a fulminant course. In patients who recover, there is lower relapse rate than young patients with ulcerative colitis. When resection is indicated, all attempts should be made to spare the rectum. Loop ileostomy and decompressive colostomy offer an excellent temporizing measure to assist the patient through the acute phase of the illness.
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PMID:Megacolon in the elderly. Ischemic or inflammatory? 46 76

Acute ischemic proctitis is a rare clinical entity caused by vascular insufficiency of the major or collateral circulation to the rectum. It usually occurs following aortic or aortoiliac operations. Six patients with acute ischemic proctitis are presented; four cases occurred after direct arterial interruption, one after accidental embolization of the blood supply to the rectum, and one from tumor edema. Bloody diarrhea was the most common symptom. Loss of anal sphincter tone was also an early sign in three patients. The diagnosis of ischemia was made by mucosal appearance on proctosigmoidoscopy and is differentiated from infectious proctitis by stool culture. Superficial mucosal ischemia was treated without surgery, but deeper levels of necrosis required laparotomy and Hartmann's resection. Rectal excision was not necessary. Four patients survived the ischemic event.
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PMID:Acute ischemic proctitis. Report of six cases. 158 61

A 9-year experience with 2137 patients undergoing infrarenal abdominal aortic reconstruction was reviewed to determine both the incidence of intestinal ischemia and the clinical, anatomic, and technical factors associated with this complication of aortic surgery. A total of 24 (1.1%) patients had overt intestinal ischemia, documented by reoperation or endoscopic findings. Of these, colon ischemia occurred in 19 (0.9%) and small bowel ischemia developed in 5 (0.2%) patients. The incidence after elective operation for aneurysmal or occlusive disease did not differ, but patients with ruptured aneurysms and those undergoing reoperative procedures for total graft replacement were at higher risk. Preoperative angiography was most helpful in ascertaining risk. Ligation of a patent inferior mesenteric artery was the most common (74%) feature in patients with colon ischemia. With preexisting inferior mesenteric artery occlusion, impairment of collateral circulation was attributable to superior mesenteric artery disease, dissection or retractor injury, prior colon resection, or exclusion of hypogastric perfusion. Bloody diarrhea was the most frequent postoperative symptom and colonoscopy the most reliable means of diagnosis. One half of patients with colon ischemia required resection after late recognition of perforation. All cases of small bowel ischemia were related to superior mesenteric artery disease or injury or use of suprarenal clamping. The overall mortality rate was 25% but rose to 50% if bowel resection was required. Intestinal ischemia remains an infrequent but serious complication of aortic surgery. Despite a multifactorial cause, identification of patients at increased risk can lead to operative strategies to reduce its occurrence.
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PMID:Intestinal ischemia complicating abdominal aortic surgery. 841 80

Lower gastrointestinal tract symptoms occur frequently in runners. The most common complaints are bowel urgency and diarrhea. Many etiologies have been proposed, including enteric fluid and electrolyte imbalance, autonomic nervous system stimulation, ischemia and mechanical trauma. The evaluation should include a review of the athlete's training program and diet, as well as a review of any preexisting gastrointestinal disease. A stool examination for occult blood should be performed in the athlete who complains of diarrhea. Treatment begins with a reduction in the intensity of workouts, followed by a gradual return to the previous level of training after the symptoms resolve. In most cases, symptoms do not recur. Dietary manipulation or antimotility agents may be helpful in some athletes. Bloody diarrhea, usually related to hemorrhagic gastritis, can be effectively treated with histamine H2-receptor antagonists.
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PMID:Runner's diarrhea and other intestinal problems of athletes. 837 91

Ischemic colitis (IC), the most common form of intestinal ischemia, ranges from superficial mucosal and submucosal injury to full-thickness mural necrosis. As risk factors include cerebrovascular disease, hypertension, diabetes mellitus, prior abdominal surgery, irritable bowel syndrome, and constipation, IC typically occurs in elderly persons with multiple comorbidities rather than young children. A 1-year-old Japanese girl receiving a stimulant laxative for constipation since age 7 months was hospitalized for fever, vomiting, and hypovolemic shock. Her abdomen was swollen, and abdominal computed tomography showed colonic distension with abundant stool. Colonic decompression and intensive care brought about rapid improvement until persistent bloody diarrhea that commenced on day 17 of illness required transfer to another hospital, where colonoscopy on day 42 showed mucosal sloughing forming pseudomembranes, as well as focal stenosis. Contrast enema on day 45 confirmed stenosis with a "thumbprint" contour at the splenic flexure. Diagnosed with IC, she received parenteral nutrition and an elemental diet. Bloody diarrhea resolved by day 75. Colonoscopy and contrast enema on day 110 showed normal mucosa and resolution of stenosis. We believe that IC arose from constipation and stimulant laxative treatment and consider this to be the first report of infantile IC complicating constipation.
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PMID:Ischemic colitis in an infant with constipation treated with stimulant laxative. 3310 79