Ischemic colitis in the elderly

Introduction to ischemic colitis in the elderly Agile ischemic colitis is an intestinal lesion that occurs due to an obstructive disease in the arteries that govern the colon or its branches, resulting in reduced or absent blood supply to the local intestinal wall. Ischemic colitis is usually spontaneous and has no specific signs or symptoms. Its clinical manifestations vary depending on its severity, extent of involvement, the speed of ischemic damage, and the tolerance of the intestinal wall to hypoxia. It is common to see elderly patients over the age of 60 who have no history of colon disease in the past and suddenly have an acute abdomen. basic knowledge The proportion of illness: 0.005% Susceptible people: the elderly Mode of infection: non-infectious Complications: peritonitis ulcerative colitis

The cause of ischemic colitis in the elderly

Poor blood supply (30%):

Relatively poor blood supply, often caused by hypovolemic shock, heart failure and other "low-flow perfusion", in addition, also seen in the inferior mesenteric artery ligation, embolism or thrombosis, abdominal aortic reconstruction or arteritis, acute colon Most of the ischemia is transient and reversible, and a small number of necrosis, perforation or persistent colonic blood loss can occur.

Elderly ischemic colitis prevention

Tertiary prevention

Primary prevention: This disease is more common in patients with arteriosclerosis, so early control of hypertension, coronary heart disease, diabetes, can delay the occurrence of this disease.

Secondary prevention: the symptoms and signs of the disease do not match, such as age, accompanied by high blood pressure, arteriosclerosis, diabetes and other diseases, sudden abdominal cramps, diarrhea, with mucus pus and blood, should first consider the disease so that earlier treatment.

Tertiary prevention:

1 Patients who are hospitalized or discharged should undergo vasodilator treatment, regularly check blood sugar, blood lipids, control high blood pressure, reduce or avoid thrombosis and ischemic colitis.

2 For patients who have undergone surgery, especially those with bowel resection, attention should be paid to intravenous nutrition. After the patient can eat, pay attention to dietary adjustment and adjust the nutritional status.

Complications of ischemic colitis in the elderly Complications peritonitis ulcerative colitis

1. Intestinal perforation: refers to the process in which intestinal lesions penetrate the intestinal wall and cause intestinal contents to overflow into the peritoneal cavity. It is one of the serious complications of many intestinal diseases, causing severe diffuse peritonitis, mainly characterized by severe abdominal pain. Symptoms and signs such as bloating and peritonitis can cause shock and death.

2, peritonitis: is a serious disease caused by bacterial infection, chemical stimulation or injury. Most of them are secondary peritonitis, which originates from abdominal organ infection, necrotic perforation and trauma.

Symptoms of ischemic colonitis in the elderly Common symptoms Diarrhea Acute abdomen peritonitis Abdominal tenderness Abdominal distension Abdominal pain Intestinal warfare Blood colonic vascular dysplasia Shock

Ischemic colitis is usually spontaneous, and its clinical manifestations are due to its severity, extent of involvement, the speed of ischemic damage, and the tolerance of the intestinal wall to hypoxia. It is common to see elderly patients over 60 years of age. There is no history of colonic disease in the past, and sudden manifestations of acute abdomen, the most consistent symptoms and signs are: abdominal pain, diarrhea and blood in the stool, this blood loss is usually very small, the pain is sudden, it is embarrassing, often Limited to the left lower abdomen, stool is anxious, and often accompanied by pain, there may be symptoms of secondary and intestinal obstruction, such as anorexia, nausea, vomiting, abdominal examination often shows abdominal distension and tenderness corresponding to the ischemic colon, generally no Significant fever, rectal examination often shows bloody stools, cardiovascular tests generally no positive findings.

Examination of ischemic colitis in the elderly

The white blood cells of the blood are mild to moderately elevated, mainly due to the increase of neutral polymorphonuclear cells. A large number of red blood cells are seen in the routine examination of stool, and occult blood is positive.

1. Imaging examination

(1) Abdominal plain film: signs of thickening of the intestinal wall edema, flatulence, and effusion of the abdomen may occur.

(2) Barium enema examination: It is of great significance, and some people think it is the first choice for this disease.

2. Fiber colonoscopy

It is of great value for the early diagnosis of this disease, but it should be noted that the gangrene type should not be used for colonoscopy.

(1) acute phase: within 72 hours of onset, mucosal congestion, edema, more scattered in the bleeding point, superficial erosion, about half of which may have superficial ulcers, lesions are segmental distribution, clear boundaries; biopsy can see inflammatory cell infiltration, Cellulose thrombosis, ductal destruction and focal hemorrhage in small blood vessels.

(2) Subacute phase: 72h to 7 days onset, typical longitudinal ulcer formation can be seen, and obvious inflammatory exudate can be seen; tissue necrosis and granulation repair can be seen on biopsy.

(3) Chronic phase: two weeks to two months after onset, only mild inflammatory changes are seen under the microscope, no characteristic, biopsy overall degeneration, fibrous tissue and granulation tissue hyperplasia, and more specific hemosiderin deposition .

Diagnosis and diagnosis of ischemic colitis in the elderly

diagnosis

Mainly based on its possible pathogenic factors or causes, corresponding clinical manifestations and a series of colon X-ray and endoscopy.

Differential diagnosis

1. Bacillary dysentery is an intestinal infectious disease caused by dysentery bacilli, which occurs in summer and autumn. The main clinical manifestations are fever, abdominal pain, diarrhea, urgency, and mucus pus and bloody stools. In severe cases, septic shock and/or toxic encephalopathy can occur.

2, ulcerative colitis and Crohn's disease are inflammatory bowel disease (IBD), both of which are characterized by recurrent intestinal ulcers, patients often present with diarrhea, mucous blood and abdominal pain, and symptoms Very similar, so sometimes it is difficult for a doctor to make a clear diagnosis.

3. Pseudomembranous enteritis (PME) is an acute intestinal inflammation. It is named after a layer of pseudomembrane on the surface of the necrotic mucosa of the small intestine or colon. This disease is prone to major surgery and the application of broad-spectrum antibiotics. Later, some people call it post-operative enteritis and antibiotic enteritis.

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