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Infectious vs Ischemic Colitis

Dr. Krumpelbeck presented a great case of undifferentiated shock that was likely 2/2 infectious colitis. Below, we outline some of the diagnosis and rx of INFECTIOUS colitis. BONUS: how to differentiate between Colonic vs Mesenteric Ischemia!


Etiologies (bloody vs nonbloody):


Bloody diarrhea (Inflammatory)

Salmonella, Campylobacter, and Shigella

Vibrio parahemolyticus, Yersinia, Aeromonas

Entamoeba histolytica

STEC

Watery Diarrhea

norovirus, rotavirus, adenoviruses, astrovirus

Cryptosporidium parvum, Giardia, Cyclospora, Entamoeba

Giardia lamblia

Listeria monocytogenes

Cyclospora cayetanensis

ETEC

C. Difficile, perfringes

Staphylococcus aureus or Bacillus cereus


Work up for Suspected acute Infectious Diarrhea: (From the IDSA and American College of Gastroenterology)

Consider testing in Large vs small volume

Lab Testing options– stool cx, ova and parasites, Shiga toxin, fecal leukocyte/lactoferrin test , molecular panels(WI diagnostics website)

Reasons to pursue testing

◦Profuse watery diarrhea with signs of hypovolemia, >6 unformed stools/ 24 hours, Severe abdominal pain, hospitalization, bloody diarrhea, Fever

◦Age ≥70 Comorbidities, such as cardiac disease, Immunocompromised status, Inflammatory bowel disease, Pregnancy, MSM

Antibiotic initiation and choice- appropriate in high risk and severe infections as above


*Avoid anti-microbials with STEC infections!!


Contrast this with.....Ischemic Colitis!


Making the Dx of Ischemic Colitis:

•History as well as CT imaging findings consistent with ischemic colitis

- edema and thickening of the bowel wall in a segmental pattern

•Colonoscopy with minimal air insufflation may show edematous, friable mucosa; erythema; and interspersed pale areas

- Better performed in the first 48 hours

•Conventional catheter-based arteriography usually not useful but can be attempted

•If signs of bowel necrosis or free air, consider surgery

- Pneumatosis coli

•primarily supportive, including Antibiotics


Contrast this with....Acute Mesenteric Ischemia!


Major differences between mesenteric and colonic ischemia:




















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