Bela
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I was reviewing lower GI conditions today and I seem to have trouble on a few concepts. I have in my notebook terms like Ischemic Colitis, Mesenteric Thrombosis, Bowel Infarction etc. but when I read into each of them, they have a lot in common. Is ischemic colitis same thing as mesenteric thrombosis? Is mesenteric thrombosis somehow associated with bowel infarction. Or it is just the different places in the lower GI that separate one from the other?
Can someone jott them down for me? Thank you very much.
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| drk1980
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Can i add tht i found a lot of overlap with pseudomembranous colitis too.
I am doing step 2 right now and had the same problem. Glad u brot it up bela :o) Will follow this thread closely for replies.
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| Bela
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1980, pseudomembranous colitis is kinda different from the conditions I mentioned above. You should usually suspect it in a pt who has been on some type of antibiotic and now c/o diarrhea.
Almost any antibiotic can cause it but the most notorious ones are: 1) Amoxicillin, 2) Clindamycin, 3) Cephalosporins.
The bug responsible for it is Clostridium difficile.
Dx: stool for Clostridium Diff toxin
Tx: 1) Stop the drug pt is taking
2) Metro (repeat twice the regimen if symptoms recur in a few days)
3) Vanco (if pt is resistant to Metro)
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| drk1980
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thanks for tht bela. Actually i ws talking more of the presentation. Some Qs tend to put down a riskfactor for all possible conditions and ask to pick the most likely condition!
Like in a Q like this....An elderly diabetic man is undergoing surgery for abdominal aortic aneurysm. He suffers an MI durin the surgery. Subsequently he is admitted to ICU for monitoring of complications. ECG shows new-onset AFib. The doctor puts him on clindamycin and some other antibiotics. Abt 2-3 days later the nurse reports that he has developed low grade fever, diffuse abdominal pain and diarrhea with blood. Labs show leukocytosis.
So wth a presentation like this, when the choices contain all those conditions, how do u pick the most suitable diagnosis? looking fwd to ur reply.
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| Bela
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Pewww. Nasty question. 
1980, you should have put down the question verbatum. The reason is that it is kinda vague. Okk, so this guy had AAA (so they want u to know that he had some atherosclerotic process going on). He then had MI, which is another indication of atherosclerotic disease. He develops A.Fib during the hospital stay and the doctor puts him on Clindamycin. (My question is WHY he was placed on clinda and other Abs?) Okkk, forget that. 2-3 days later, he develops bloody diarrhea, abd pain, and fever. Well, I'd have thought this would be an embolic episode since the guy has A.Fib but according to Dr. Fischer, 48 hrs is not enough for the pt to develop a clot. So 2-3 days is kinda in a shady area. So, I'd look at the CMP for metabolic acidosis (lactic acidosis) and that will give me the answer. On the other hand, Clinda could be it but pts usually have clinda side effects after 5-10 days of treatment. So, it doesn't sound enough but it could be it.
Hence, what else was there in the question that u're not sharing with us?
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| drk1980
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lol...sorry abt tht! i realised while typing it wsnt fair as i cud be missing out on some vital clues. However my subscription to the Q source had expired so had to rely on memory.
Actually i thot thr r some hard n fast rules, i'm unaware of, to distinguish betwn these entities. Anyhow, my notes tell me the ans to this (sorta) Q was 'bowel infarction' as a complictn of AAA repair. And it went on to say u hv to r/o PMC pseudomembranous colitis.
So if the Dx is inconclusive we must perform colonoscopy or proctosigmoidoscopy. I was wondering besides the temporal difference, is thr a way to rule out PMC pseudomembranous colitis from clinical presentn alone? Also in ischemic colitis/bowel infarction (friable mucosa?) is colonoscopy considered safe?
Anyway, if i do catch the Q verbatim smwhr on the web i'll be sure to post it here. meanwhile thanks for the useful discussion!
Edited by drk1980 on 08/15/06 - 06:30 AM
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| Bela
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Ufff, I hate abbreviations. What does PMC stand for?
Well, if you see my very original post, I was asking if the lower GI conditions were separated by location. Yes, bowel infarction could be the answer in the above question. But then, they'd have to give you the location. As far as I know, bowel infarction as a complication of Abdominal aorta surgery mainly occurs in the inferior mesenteric A and it's a/w with lactic acidosis. This would differentiate it from mesenteric ischemia, which usually happens in superior mesenteric A.
As for colonoscopy, I think it is the procedure of choice in case of bowel infarction. You would be able to see clearly the infarcted bowel. Is it dangerous? I do not think so.
If you're suspecting Mesenteric Thrombosis, screening test would be Mesenteric Duplex U/S. Confirmatory test: Splanchic Angiography.
I don't know if this helps in any way. I wish someone who has a better understanding than I do explained.
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