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IschemicColitisRi陳宏彰第一页，共三十页。ReferencebooksHarrison’sonline15thMarx:Rosen'sEmergencyMedicine:ConceptsandClinicalPractice,5thed.,Copyright©2002Mosby,Inc第二页，共三十页。IschemicColitisIschemiaofthecolonmostoftenaffectstheelderly(90%ofpatients>60y/o).Ischemiccolitisisalmostalwaysnonocclusive.(emboliarethemostcommoncauseofacutemesentericischemia)Shuntingofbloodawayfromthemucosamaycontributetothiscondition,butthemechanismisunknown.第三页，共三十页。IschemicColitisMostpatientsischemiaoccurssecondarytoarteriolarshunting,spasm,orpoorperfusionofmucosalvessels.Mostcasesinvolvethesplenicflexure,whichissuppliedbyend-arteries.Therectumisusuallyspared,becauseitsbloodsupplyisdifferentfromtherestofthecolonandlessdependentontheinferiormesentericartery.Marx:Rosen'sEmergencyMedicine:ConceptsandClinicalPractice,5thed第四页，共三十页。TypesofIschemicColitis1.Acutefulminantischemiccolitis2.SubacuteischemiccolitisHARRISON’SONLINE15TH第五页，共三十页。TypesofIschemicColitisGangrenousischemiccolitisacompletelossofarterialflowcausesbowelwallinfarctionandgangrene,whichcanprogresstoperforation,peritonitis,anddeath.Stricturingischemiccolitisagrossimpairmentofthearterialsupply,leadingtohemorrhagicinfarctionofthemucosa,whichulcerates,healsbyfibrosis,andfinallyleadstostenosis.Transientischemiccolitisatransient,reversibleimpairmentofthearterialsupply,whichcausesapartialmucosalsloughthathealsbymucosalregenerationinafewdays.themostcommonMarx:Rosen'sEmergencyMedicine:ConceptsandClinicalPractice,5thed第六页，共三十页。Acutefulminantischemiccolitismanifestations1.Theonsetischaracteristicallyacute,withgeneralizedlowerabdominalpain,usuallyintheleftlowerquadrant,followedwithin24hoursbybloodydiarrheaorrectalbleeding.2.Dilationofthecolonandphysicalsignsofperitonitisareseeninseverecases.3.Withthegangrenoustype,bothsymptomsandsignsprogressrapidly.第七页，共三十页。AcutefulminantischemiccolitisDiagnosticStrategyNospecificserummarkersproveninthediagnosisofintestinalischemia....