Difference between revisions of "Ischemic colitis classification"

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==Overview==
 
==Overview==
  
Ischemic colitis may be classified based on symptom progression into [[hyperactive]] phase, [[paralytic]] phase, [[shock]] phase. Also, based on its clinical course into two types: [[acute]] ischemic colitis or [[chronic]] ischemic colitis.
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Ischemic colitis may be classified on the degree of the [[Histopathology|histopathological]] damage in the [[Colon (anatomy)|colonic]] wall as reversible ischemic colopathy ([[Submucosa|submucosal]] or intramural bleeding), transient colitis, chronic segmental [[ischemia]], [[Gangrene|gangrenous]] [[colitis]], and universal [[fulminant]] [[colitis]]. Also, based on its clinical course into two types: [[Acute (medicine)|acute]] [[Ischemia|ischemic]] [[colitis]] or [[Chronic (medical)|chronic]] [[Ischemia|ischemic]] [[colitis]].
==History and Symptoms==
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==Classification==
Ischemic colitis may be classified based on symptom progression into:<ref name="pmid3045452">{{cite journal |vauthors=Hunter GC, Guernsey JM |title=Mesenteric ischemia |journal=Med. Clin. North Am. |volume=72 |issue=5 |pages=1091–115 |year=1988 |pmid=3045452 |doi= |url=}}</ref>
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Ischemic colitis can be classified into the following types based on clinical features of disease:<ref name="pmid3045452">{{cite journal |vauthors=Hunter GC, Guernsey JM |title=Mesenteric ischemia |journal=Med. Clin. North Am. |volume=72 |issue=5 |pages=1091–115 |year=1988 |pmid=3045452 |doi= |url=}}</ref><ref name="NikolicKeck2017">{{cite journal|last1=Nikolic|first1=Amanda L.|last2=Keck|first2=James O.|title=Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management|journal=ANZ Journal of Surgery|year=2017|issn=14451433|doi=10.1111/ans.14237}}</ref><ref name="MontoroBrandt2010">{{cite journal|last1=Montoro|first1=Miguel A.|last2=Brandt|first2=Lawrence J.|last3=Santolaria|first3=Santos|last4=Gomollon|first4=Fernando|last5=Puértolas|first5=Belén Sánchez|last6=Vera|first6=Jesús|last7=Bujanda|first7=Luis.|last8=Cosme|first8=Angel|last9=Cabriada|first9=José Luis|last10=Durán|first10=Margarita|last11=Mata|first11=Laura|last12=Santamaría|first12=Ana|last13=Ceña|first13=Gloria|last14=Blas|first14=Jose Manuel|last15=Ponce|first15=Julio|last16=Ponce|first16=Marta|last17=Rodrigo|first17=Luis|last18=Ortiz|first18=Jacobo|last19=Muñoz|first19=Carmen|last20=Arozena|first20=Gloria|last21=Ginard|first21=Daniel|last22=López-Serrano|first22=Antonio|last23=Castro|first23=Manuel|last24=Sans|first24=Miquel|last25=Campo|first25=Rafael|last26=Casalots|first26=Alex|last27=Orive|first27=Víctor|last28=Loizate|first28=Alberto|last29=Titó|first29=Lluçia|last30=Portabella|first30=Eva|last31=Otazua|first31=Pedro|last32=Calvo|first32=M.|last33=Botella|first33=Maria Teresa|last34=Thomson|first34=Concepción|last35=Mundi|first35=Jose Luis|last36=Quintero|first36=Enrique|last37=Nicolás|first37=David|last38=Borda|first38=Fernando|last39=Martinez|first39=Benito|last40=Gisbert|first40=Javier P.|last41=Chaparro|first41=María|last42=Bernadó|first42=Alfredo Jimenez|last43=Gómez-Camacho|first43=Federico|last44=Cerezo|first44=Antonio|last45=Nuñez|first45=Enrique Casal|title=Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)|journal=Scandinavian Journal of Gastroenterology|volume=46|issue=2|year=2010|pages=236–246|issn=0036-5521|doi=10.3109/00365521.2010.525794}}</ref><ref name="O’NeillElder2011">{{cite journal|last1=O’Neill|first1=Stephen|last2=Elder|first2=Kenny|last3=Harrison|first3=Sarah J.|last4=Yalamarthi|first4=Satheesh|title=Predictors of severity in ischaemic colitis|journal=International Journal of Colorectal Disease|volume=27|issue=2|year=2011|pages=187–191|issn=0179-1958|doi=10.1007/s00384-011-1301-x}}</ref>
* [[Hyperactive]] phase
 
  
* [[Paralytic]] phase
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==== Reversible ischemic colopathy ====
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* Characterized by [[Submucosa|submucosal]] [[Bleeding|hemorrhage]] at [[endoscopy]], with involvement of [[Superficial (human anatomy)|superficial]] [[Mucous membrane|mucosa]]
 +
* Self-limiting
  
* [[Shock]] phase
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==== Transient (most common form) ====
Ischemic colitis can be classified based on its clinical course into two types:  
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* Present with [[abdominal pain]], [[rectal bleeding]] and full-thickness involvement of the [[Mucous membrane|mucosa]]
*[[Acute]] ischemic colitis
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*[[Chronic]] ischemic colitis.
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==== Chronic segmental or chronic ulcerative ====
|
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* Persistent symptoms or recurrent episodes of [[pain]], [[rectal bleeding]], [[diarrhea]], and segmental colitis on [[imaging]]
{{familytree/start
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* [[Resection]] is usually curative
|summary=Sample 1}}
+
 
 +
==== [[Ischemia|Ischemic]] colonic [[Stenosis|stricture]] ====
 +
* Found at follow-up [[endoscopy]]
 +
 
 +
==== [[Gangrene|Gangrenous]] colitis ====
 +
* Suspected when there is increasing [[abdominal pain]], [[Medical sign|signs]] of local or generalized [[peritonitis]], [[fever]] or [[ileus]]
 +
 
 +
==== Universal [[fulminant]] [[pancolitis]] ====
 +
* Presents acutely with severe symptoms, progressive transmural [[infarction]] and [[necrosis]] of the entire [[Colon (anatomy)|colon]]
 +
* Results in [[sepsis]] and [[perforation]]
 +
* 75% [[mortality rate]]
 +
* [[Symptom|Symptoms]] include [[sepsis]], severe [[abdominal pain]], [[peritonitis]] and [[rectal bleeding]]
 +
 
 +
=== Percentage for each type: ===
 +
{|
 +
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Classification of ischemic colitis by percentage
 +
|-
 +
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Type
 +
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Percentage (%)
 +
|-
 +
| style="background:#DCDCDC;" align="center" + |Reversible ischemic colopathy
 +
| style="background:#F5F5F5;" align="center" + |3-26.1
 +
|-
 +
| style="background:#DCDCDC;" align="center" + |Transient
 +
| style="background:#F5F5F5;" align="center" + |45
 +
|-
 +
| style="background:#DCDCDC;" align="center" + |[[Chronic (medical)|Chronic]] segmental or ulcerative
 +
| style="background:#F5F5F5;" align="center" + |17.9-25
 +
|-
 +
| style="background:#DCDCDC;" align="center" + |[[Ischemia|Ischemic]] colonic [[Stenosis|stricture]]
 +
| style="background:#F5F5F5;" align="center" + |10-15
 +
|-
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| style="background:#DCDCDC;" align="center" + |[[Gangrene|Gangrenous]] colitis
 +
| style="background:#F5F5F5;" align="center" + |9.9-19
 +
|-
 +
| style="background:#DCDCDC;" align="center" + |Universal [[fulminant]] [[pancolitis]]
 +
| style="background:#F5F5F5;" align="center" + |1-2.5
 +
|}
 +
 
 +
Ischemic colitis can be classified into the following types based on clinical course of disease:
 +
 
 +
==== [[Acute]] ischemic colitis ====
 +
*[[Thromboembolism|Occlusive]]
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**Due to [[Artery|arterial]] or [[Vein|venous]] [[thrombosis]] blocking [[blood]] supply
 +
*Non-Occlusive
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**Due to [[Shock|hypoperfusion]] of the [[Colon (anatomy)|colon]]
 +
 
 +
==== [[Chronic]] ischemic colitis ====
 +
{{familytree/start|summary=Sample 1}}
 
{{familytree | | | | | | | | A01 |A01=Ischemic colitis}}  
 
{{familytree | | | | | | | | A01 |A01=Ischemic colitis}}  
 
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
 
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
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{{familytree | |,|-|^|.| | | | | | | | | | }}
 
{{familytree | |,|-|^|.| | | | | | | | | | }}
 
{{familytree | D01 | | D02 | | | | | | |D01=Occlusive |D02=Non-occlusive|}}
 
{{familytree | D01 | | D02 | | | | | | |D01=Occlusive |D02=Non-occlusive|}}
{{familytree{{familytree/end}}
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{{familytree/end}}
  
 
==References==
 
==References==
 
{{Reflist|2}}
 
{{Reflist|2}}
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{{WH}}
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{{WS}}
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[[Category:Gastroenterology]]
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[[Category:Medicine]]
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[[Category:Disease]]
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[[Category:Emergency medicine]]
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[[Category:Up-To-Date]]

Latest revision as of 14:06, 5 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]; Mehrian Jafarizade, M.D [3]

Overview

Ischemic colitis may be classified on the degree of the histopathological damage in the colonic wall as reversible ischemic colopathy (submucosal or intramural bleeding), transient colitis, chronic segmental ischemia, gangrenous colitis, and universal fulminant colitis. Also, based on its clinical course into two types: acute ischemic colitis or chronic ischemic colitis.

Classification

Ischemic colitis can be classified into the following types based on clinical features of disease:[1][2][3][4]

Reversible ischemic colopathy

Transient (most common form)

Chronic segmental or chronic ulcerative

Ischemic colonic stricture

Gangrenous colitis

Universal fulminant pancolitis

Percentage for each type:

Classification of ischemic colitis by percentage
Type Percentage (%)
Reversible ischemic colopathy 3-26.1
Transient 45
Chronic segmental or ulcerative 17.9-25
Ischemic colonic stricture 10-15
Gangrenous colitis 9.9-19
Universal fulminant pancolitis 1-2.5

Ischemic colitis can be classified into the following types based on clinical course of disease:

Acute ischemic colitis

Chronic ischemic colitis

 
 
 
 
 
 
 
Ischemic colitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute ischemic colitis
 
 
 
 
 
 
 
Chronic ischemic colitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Occlusive
 
Non-occlusive
 
 
 
 
 
 

References

  1. Hunter GC, Guernsey JM (1988). "Mesenteric ischemia". Med. Clin. North Am. 72 (5): 1091–115. PMID 3045452. 
  2. Nikolic, Amanda L.; Keck, James O. (2017). "Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management". ANZ Journal of Surgery. ISSN 1445-1433. doi:10.1111/ans.14237. 
  3. Montoro, Miguel A.; Brandt, Lawrence J.; Santolaria, Santos; Gomollon, Fernando; Puértolas, Belén Sánchez; Vera, Jesús; Bujanda, Luis.; Cosme, Angel; Cabriada, José Luis; Durán, Margarita; Mata, Laura; Santamaría, Ana; Ceña, Gloria; Blas, Jose Manuel; Ponce, Julio; Ponce, Marta; Rodrigo, Luis; Ortiz, Jacobo; Muñoz, Carmen; Arozena, Gloria; Ginard, Daniel; López-Serrano, Antonio; Castro, Manuel; Sans, Miquel; Campo, Rafael; Casalots, Alex; Orive, Víctor; Loizate, Alberto; Titó, Lluçia; Portabella, Eva; Otazua, Pedro; Calvo, M.; Botella, Maria Teresa; Thomson, Concepción; Mundi, Jose Luis; Quintero, Enrique; Nicolás, David; Borda, Fernando; Martinez, Benito; Gisbert, Javier P.; Chaparro, María; Bernadó, Alfredo Jimenez; Gómez-Camacho, Federico; Cerezo, Antonio; Nuñez, Enrique Casal (2010). "Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)". Scandinavian Journal of Gastroenterology. 46 (2): 236–246. ISSN 0036-5521. doi:10.3109/00365521.2010.525794. 
  4. O’Neill, Stephen; Elder, Kenny; Harrison, Sarah J.; Yalamarthi, Satheesh (2011). "Predictors of severity in ischaemic colitis". International Journal of Colorectal Disease. 27 (2): 187–191. ISSN 0179-1958. doi:10.1007/s00384-011-1301-x. 

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