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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Geriatric patients are preferentially involved in ischemic bowel disease. The sudden occlusion of the large mesenteric arteries (a. mesenterica superior (more frequently) and inferior) is followed by intestinal gangrene and peritonitis with a poor prognosis and a high letality (greater than 90%). In chronic intestinal ischemia the leading clinical symptom is postprandial pain ('claudicatio intestinalis'). In some cases of acute mesenteric artery occlusion no embolus or thrombus will be found. In these cases the circulation in the arteriosclerotic vessels falls below a critical value due to cardiac insufficiency, shock, digitalis overdose and others. In less severe ischemia the mucosa is involved being most sensitive to O2 deprivation. It usually regenerates within a few days. This form is found more frequently in the colon than in other parts of the gut (about 40%): ischemic colitis. The therapy - if possible in acute, fulminant ischemia or if necessary in chronic intestinal ischemia - is surgical consisting in reconstructive procedures of the mesenteric circulation.
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PMID:[Ischemic bowel disease (author's transl)]. 1 31

Griffiths' point is defined as the site of (a) communication of the ascending left colic artery with the marginal artery of Drummond, and (b) anastomotic bridging between the right and left terminal branches of the ascending left colic artery at the splenic flexure of the colon. It is upon this critical point at the splenic flexure that collateral circulation between the superior mesenteric artery and the marginal artery branch of the inferior mesenteric artery supplying the descending colon is dependent. Analysis of arteriographic studies shows that anastomosis at Griffiths' point is present in 48%, poor or tenuous in nine percent, and absent in 43%. This critical point is of significance in occlusive vascular impairment of the left colon, both in spontaneous instances and following surgical ligation of the inferior mesenteric artery, and in "nonocclusive" ischemic colitis. Its relationship to arteriosclerotic stenoses and low flow states is discussed. Individuals with absence of dependable anastomoses at Griffiths' point at the splenic flexure may be particularly vulnerable to low perfusion states and develop the syndrome of ischemic colitis. Complete arteriographic evaluation is necessary in ischemia of the colon. This includes particularly assessment of atherosclerotic changes at or near the ostia of the major visceral arteries and the vascular arrangement at Griffiths' point.
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PMID:Griffiths' point: critical anastomosis at the splenic flexure. Significance in ischemia of the colon. 17 88

Blood flow disturbances in the gastrointestinal tract can lead to serious illness. They can be acute or chronic, their cause may be arterial or venous occlusion or hypotonia. Lesions of the gastrointestinal tract caused by ischemia depend on localisation, acuteness and degree of the blood flow disturbance. They may reach from focal and segmental ischemic lesions to extensive necroses of the entire intestinal tubes. The most serious ischemic disease is the embolic and thrombotic occlusion of the arteria mesenterica superior due to previous arterosclerotic damage. Infarction of a large part of the intestines and peritonitis can be the consequence. These patients' only chance of survival is early diagnosis--as a rule exclusively via angiography--and immediate surgery. Chronic occlusion of the arteria mesenterica superior leads to angina abdominalis which mainly occurs after food intake and can last for hours. The reason may also be a general arteriosclerosis. Men are affected more frequently and at a younger age than women. As a consequence of lowered intestinal blood flow these patients suffer from malabsorption and heavy weight loss. Conservative therapy is not effective. These patients, too, will have to be treated surgically after previous angiography. Vascular disease with decreased blood flow as its consequence can be found in a number of inflammatory diseases, in malign hypertensian, in collagen disease and in other more rare diseases as pseudoxanthoma elasticum or Ehlers-Danlos-syndrome. In the case of ischemic colitis arterial and more rarely venous occlusions cause decreased blood flow in the big bowel. A frequent consequence is colitis in the left colon which is characterized by acuteness, pain in the left side of the abdomen and by heavy rectal bleeding. Diagnosis is established by means of endoscopy, barium enema and angiography. Primarily therapy of ischemic colitis is of the conservative type. In severe cases with gangrene and peritonitis the colon has to be resected.
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PMID:[Disorders of the blood circulation in the gastrointestinal tract]. 32 26

The blood flow within the walls of the digestive tract must be sufficient to maintain its structural and functional integrity. All episodes of vascular insufficiency cause ischemic damage to the organ and carry the threat of diffuse or focal necrosis. Certain forms of ischemic colitis or proctitis arise from episodes of reduced peripheric or splanchnic blood flow; indeed, those that do not culminate in necorsis of the colonic wall are more frequently caused by hemodynamic disorders than by vascular occlusions. The crisis is often mitigated by the development of collateral circulation, which is nevertheless of rather meager quality, such that the patients are very vulnerable to subsequent slight changes in cardiac output. Necrotic, gangrenous ischemic colitis arises from a combination of occlusive damage to the arteries and general hemodynamic disturbances. The vascular insufficiency might be slight or severe, temporary or long-lasting, localized or diffuse. In addition, the attack occurs in a septic medium in the presence of an abundant microbial flora that may be highly pathogenic. Thus infection complicates and aggravates the ischemic damage, with the result that the gangrenous aspect of the lesions tends to hide their ischemic origin. Indeed, the variability of the manifestations of the disease represents one of its primary characteristics and is a function of the different causative factors. A knowledge of the anatomy and pathophysiology of the splanchnic circulation and its hemodynamics is essential for a full appreciation of the diagnosis and treatment of the disorders and for the adoption of the aggressive approach necessary to improve the poor prognosis of ischemic diseases of the colon and rectum. The salient points have been stressed in the present chapter. The features of the different forms of the disease have been described, together with the necessary medical treatment and the indications for surgical for surgical intervention. In the relatively rare cases where operation is necessary, the tactics and techniques have been described. All treatment should be based on (a) constant, prolonged intensive care; (b) precise monitoring of any change in status; and (c) rapid excision of any necrotic (often gangrenous) tissue. Ischemic colitis is most likely to occur in elderly patients with a history of cardiovascular disease, but it is not excluded in younger individuals. It is a frequent entity and is potentially lethal. Although its clinical, radiological, and anatomical characteristics permit its classification as a separate disease, it is often confused with other disorders of the colon. Although the abdominal surgeon is most likely to be concerned with this disease, the vascular surgeon who attacks the lower aorta should always be on the lookout for possible occurrences of segmentary ischemia of the distal colon as a result of his intervention.
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PMID:Ischemic diseases of the large intestine. 38 38

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

A case report of subacute, reversible ischemic colitis associated with use of oral contraceptives (OCs) is reported. A 19-year-old woman was admitted to the hospital with chief complaints of abdominal cramps, nausea, vomiting, diarrhea, and rectal bleeding of 2 days' duration. Past medical history and family history were noncontributory. The patient was receiving no medication other than Norinyl 2 (2 mg of norethindrone and .1 mg of mestranol), which she had been taking for 6 months. 2 days before admission the patient had taken 100 mg of dimenhydrinate and 2 ExLax tablets (90 mg of phenolphthalein) for constipation. Colonic roentgenograms revealed impaired mesenteric circulation and bowel ischemia; OC-induced ischemic bowel disease was diagnosed. Patient symptoms subsided within 96 hours of discontinuing the OC and initiating supportive therapy (including intravenous fluid infusion, nasogastric suction, analgesics, and antiemetics). When a repeat barium enema was performed, it showed resolution of the ischemia. In a short review following the case report, these drugs were indicted in causation of colitis-like syndrome: amoxicillin, ampicillin, cephazolin, chloramphenicol, chlorpropamide, clindamycin, cloxacillin, cotrimoxasole, cyclophosphamide, digitalis, ergotamine tartrate, flucytosine, fluorouracil, gold salts, laxative and cathartic abuse, mercurous chloride, methyldopa, penicillin V, and tetracycline. Ischemic bowel disease secondary to OC use is a rare but important complication because of its significant morbidity and potential mortality, and because of the widespread use of the drugs. The case report emphasizes the need to consider the differential diagnosis of acute vascular insult with bowel ischemia when acute abdominal pain progressing to bloody diarrhea occurs in young women taking OCs.
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PMID:Oral contraceptive-induced ischemic bowel disease. 48 72

Ischemic colitis or proctitis shows three evolutionary stages. a. complete recovery, b. fibrous stenosis, and c. acute ischemia leading to gangrene. The two first stages result more frequently from hemodynamic disorders than from vascular occlusions because, in the presence of the latter, collateral circulation develops. In addition, the colonic ischemia occurs in a septic medium in the presence of an abundant microbial flora which may be highly pathogenic.
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PMID:[Blood flow disorders of the colon and rectum and their therapy]. 54 43

We describe our observations on abdominal roentgenograms without preparation in two cases of segmental colon infarct and eighteen cases of ischemic colitis. In both infarct cases a colic ileus was noted. In one patient the infarcted loop appeared as gas contrasted. In the ischemic cases there were, in addition to the bowel ileus: a colectasis in two patients, a collapsed segment in thirteen and a gas-filled segment in three. When associated to a significant clinical situation the two latter images have some diagnostic value. In the majority of patients, the contrast enema made possible a diagnosis of ischemic colitis; in three it shaved the sigmoid narrowing responsible for the ischemia.
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PMID:[Plain film findings and contrast enema in colon ischemia (author's transl)]. 66 84

A 50-year-old woman developed ischemic colitis temporally related to ingestion of a large dose of ergotamine tartrate. The patient did not have cardiovascular, metabolic, or inflammatory conditions predisposing to bowel ischemia. To our knowledge, this is the first patient proved to have developed bowel ischemia secondary to ergot toxicity.
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PMID:Ischemic bowel disease attributable to ergot. 85 76

The ultrastructural injury that develops sequentially in the ascending colon during experimentally induced ischemia was examined in 6 halothane-anesthetized horses. Colonic ischemia was created by 2 types of vascular occlusion 24 cm proximal and distal to the pelvic flexure. In all horses, transmural vascular compression was created. The colonic venous circulation was obstructed in 3 horses, whereas in the other 3 horses, arterial and venous circulation was obstructed. Two additional horses were anesthetized as controls for determination of any morphologic alterations associated with the experimental protocol. Full-thickness colonic biopsy specimens were obtained from the antimesenteric border of the pelvic flexure at 0, 0.25, 0.5, 1, 1.5, 1.75, 2, 2.25, 2.5, 3, 3.5, 4, 4.5, and 5 hours during occlusion, and were studied by light and transmission electron microscopy. Morphologic alterations did not develop in the colon of control horses. Mucosal congestion was observed by light microscopy in the colon of horses with experimentally induced ischemia, but congestion developed early in those with obstructed colonic venous circulation, compared with those having arterial and venous obstruction. Inter- and intracellular vacuolation and loss of staining initially resulted in groups of 3 to 5 superficial luminal epithelial cells. Alterations in the glandular epithelium lagged behind those in the superficial epithelium, but were observed in both groups by 2 hours of obstruction. These changes progressed to 100% sloughing of all epithelium by 4.5 to 5 hours. The initial cellular alterations, which were observed by transmission electron microscopy, developed at 0.25 hour in horses with colonic venous obstruction and was characterized by inter- and intracellular edema.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ultrastructural mucosal injury after experimental ischemia of the ascending colon in horses. 145 41


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