Ischemic Colitis

Ischemic Colitis
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The Emergency Situation and the Criteria defining the Emergency
A 65-year old male patient reported to the hospital’s emergency department after a series of bowel-related pains. The most outstanding symptoms were the tenderness and pain in the stomach that recurred after every three minutes. There was a feeling of urgency to move the bowel, diarrhea, and a maroon-colored blood or bright red color in the stool. The pain remained persistent on the left side of the belly and hence an immediate clinical diagnosis was required. To properly define the condition and the nature of the emergency, two tests were recommended. The abdominal and ultrasound CT scans were to be administrated so as to provide images of the colon in ruling out both the ischemic colitis condition and probably the inflammatory bowel disease. The other test was the MRI and CT angiographies to provide images on the blood flow to the intestines and to examine the availability of any blocked intestines. The latter test was strongly recommended since the patient’s reported symptoms indicated of the possibility of a severe ischemic colitis.
The Patient’s Signs and Symptoms and their Pathophysiology
The patient complained of regular, recurring abdominal pains particularly on the right side of the stomach. Also, the cramping and tenderness in the stomach which accompanied abdominal pains (Mayo Clinic, 2017). At times, the patient would pass blood instead of stool and sometimes complain of a bright red and a maroon-colored stool with blood stains.

There was nausea, diarrhea, and a regular urgency to move the bowels and pass stool (Mayo Clinic, 2017). There was a risk of severe complications since the patient complained that the above symptoms mostly affected the right side of the lower abdomen. Recurrent infections and loss of weight were also added as secondary symptoms facing the patient in recent times before he reported for a clinical emergency.
Steps to Determine the Patient’s Final Diagnosis
The first step would be to conduct a stool analysis to determine the infection underlying the reported symptoms. The hospital will further undertake a colonoscopy test to provide detailed images of the inner abdomen and to rule out of a possible ischemic injury. An MRI angiography or CT scan will further be undertaken to determine possible intestinal fractures, trace blocked intestines, and examine the overall gastrointestinal blood flow. Finally, in the determination of the final diagnosis, it would be clinically prudent to obtain colon scans through the abdominal CT scans to establish or rule out other likely conditions like IBD and ischemic colitis. However, before undertaking the above clinical examinations, the patient’s weight and blood pressure will be taken as a basis for further tests.
Identification of Specialists and Staff for Consultation
The first physician to consult is the gastroenterologist who is specialized in the examination of the digestive conditions and illnesses. With specialty in diagnosis, management, and treatment of digestive tract bleeding and abdominal discomfort and pain, the gastroenterologist will provide a clinical overview of food movement in the abdominal region, a breakdown of the patient’s biliary system, and a professional opinion of the likelihood for diverticular disease such as the Crohn’s illness and disease, irritable bowel syndrome, colitis, and the gastroesophageal reflux condition. (Health Communities, 2015) An endocrinologist will provide a clinical evaluation of glandular and hormonal systems with a special emphasis on specific glands such as the pancreas, thyroid, and adrenal glands. As an internal medical specialist, the endocrinologist will assist in the restoration of any possible hormonal imbalances by the patient that may result as a consequence of the ischemic colitis or irritable bowel syndrome. If possible, the family practitioner will be contacted to provide a clinical overview of the patient and avail any past treatment records and clinical evaluations for the patient.
Any Relevant Evidence-based Clinical Guidelines
The pathophysiology of the ischemic colitis is an important area of research to guide the diagnosis and management of this particular condition. Usually, the colon is largely supplied by a relatively low blood levels with a less developed microvasculature plexus as opposed to the bowel. The National Center for Biotechnology identifies that two major arteries supply blood to the colon and whose examination will help rule out primary symptoms like blood in the stool and a sharp abdominal pain on the left side. The superior mesenteric artery which channels and directs the blood to both the traverse and ascending colons and the inferior artery that channels to the sigmoid and the descending colons. Clinical scholarly research from authoritative sources like NCBI will provide a theoretical basis to rule out the ischemic colitis while providing clinical information that is altogether pertinent in the diagnoses and medication stages. The diagnosis and management of the ischemic colitis are clinically challenging because the colon ischemia is highly variable and the symptoms are not specific. This means diagnosis will require a relatively higher index of suspicion. The next source to be examined includes literature on recent treatment and diagnosis including scholarly literature and researchers from the World Health Organization WHO. In-house literature and sources from hospitals, health departments, and established clinics are present vital sources of information to identify, diagnose, and treat ischemic colitis based purely on signs reported by the patient.
The Advanced Clinical Procedures
The various lab markers for ischemic colitis will be investigated such as CPK, LDH, lactate, and amylase levels. Also, intestinal fatty acids, inorganic phosphate, alkaline phosphatase, and leucocytes. These markers will be investigated and examined to rule out a possible cause of acute bowel ischemia. While none of these markers has been found to be specific and particular in the treatment of ischemic colitis, they altogether hold water in the identification of specific causal factors and the administration of diagnosis thereof. A classic clinical procedure in the identification of ischemic colitis is imaging techniques (Grand Canyon, 2015). For example, a plain abdominal radiography will be conducted towards the identification of non-specific findings such as air-filled loops, thumb printing, exhausted bowel, colonic peristalsis, and similar symptoms associated with ischemic colitis. Secondly, the colonoscopy test will be administered as a diagnostic measure for the confirmation of the Ischemic colitis. The use of colonoscopy as the clinical and medical procedure is to facilitate the analysis of biopsies alongside helping in the visualization of colonic mucosa.
Advanced Technology and Monitoring for Ischemic Colitis
Serial Radiography and Colonoscopy Examinations
A series of radiographic and colonoscopy examinations are critical in the evaluation, management, and monitoring of the patient ischemic colitis condition (NCBI, 2017). The rationale for colonoscopy include:
Gaining basic knowledge and understanding through textbooks and clinical videos.
Leveraging consultations from gastroenterologists on lectures for insertion methods.
Insertion with the patient through endoscopic insertion to up to the SD section or junction. During this stage, x-ray and UPD are also allowed.
Endoscope insertion till the splenic flexure. There will be the use of X-ray and UPD.
Endoscope insertion until it reaches the cecum (Greenwald et al. 2008).
Use the results to administer drugs, medication etc.
Mild cases of IC can be clinically monitored based on an outpatient arrangement through; [a] liquid diet or liquid nutritional supplements, [b] use of pharmaceutical antibiotics, and [c] clinical observation and regular medical monitoring. Also, parenteral nutrition will be recommended for the patient is s/he needs a long and adequate bowel rest. Also, local corticosteroids may be used if s/he exemplifies chronic ischemic colitis (Green et al. 2005). However, the use of corticosteroids should be undertaken with caution since they are claims of them prompting colonic perforation as a result of ischemic infraction or damage.
Detailed Steps for the Evidence-based Plan of Care
The first step is the identification of the emergency situations. This will involve examining the patient for any outstanding signs and symptoms such as [1] abdominal pains, [2] blood in the stool, and [3] the frequency of passing stool.
The next step will be to determine the patient’s final diagnosis including; conducting stool tests, conducting an MRI angiography or CT scan to determine possible intestinal fractures, trace blocked intestines, and examine the overall gastrointestinal blood flow.
The third step is to make consultations with relevant practitioners. The gastroenterologist and the endocrinologists will both be consulted to assist with clinical information and medical guidance on how to proceed with treatment.
The fourth step is the identification of any relevant evidence-based materials. The National Center for Biotechnology Information and any other authoritative sources will be consulted to assist with diagnosing information with regards to ischemic colitis.
Finally, the diagnosis will rely on the advanced clinical practices; including the use of any technology monitoring methods. A series of radiographic and colonoscopy examinations will be undertaken as they are critical in the evaluation, management, and monitoring of ischemic colitis. The above steps reflect the evidence-based practices that will be undertaken as part of care planning for a patient with ischemic colitis.
Summary
The paper begins by defining the emergency situation of a 65-year old patient. The condition detected is ischemic colitis and is characterized by bowel-related pains. The most outstanding symptoms also are tenderness and pain in the stomach that recurred after every three minutes. There was a feeling of urgency to move the bowel, diarrhea, and a maroon-colored blood or bright red color in the stool. The pain remained persistent on the left side of the stomach and hence an immediate clinical diagnosis was required. Two major types of tests, both the CT scans and MRI angiography are identified as suitable diagnosis methods. The paper proceeds to identify the relevant practitioners that will be consulted as part of the diagnosis. Both the gastroenterologist and the endocrinologists will be consulted to assist with clinical information and medical guidance on how to proceed with treatment. The paper further identifies that advanced clinical practices will be required to offer a diagnosis of ischemic colitis. For example, a plain abdominal radiography will be conducted towards the identification of non-specific findings such as air-filled loops, thumb printing, exhausted bowel, colonic peristalsis, and similar symptoms associated with ischemic colitis. The above analysis surmises the paper on an emergency situation of ischemic colitis.
References
Grand Canyon University. (2015). Current Medical Diagnosis, Management, and Treatment of Different Disease. The Grand Canyon University. The 5th Edition.
Green BT, Tendler DA. (2005). Ischemic colitis: A Clinical Review. South Med J. 98:217–222.
Greenwald DA, Brandt LJ. (2008). Colonic ischemia. J Clin Gastroenterol. 27:122–128.
Health Communities. (2015). Gastrointestinal Symptoms. The Health Communities Official. Retrieved from http://www.healthcommunities.com/general-gi-symptoms/what-is-a-gastroenterologist.shtml
Mayo Clinic. (2017). Ischemic Colitis. The Mayo Clinic Official. Retrieved from https://www.mayoclinic.org/diseases-conditions/ischemic-colitis/symptoms-causes/syc-20374001NCBI. (2017). Advances in the Diagnosis and Management of Ischemic Colitis. The National Center for Biotechnology Information NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591371/