Summary Background Colon ischaemia is the most common ischaemic disorder of the gastrointestinal system, can affect any segment of the colon, and may present with a range of symptoms. Diagnosis can be challenging due to symptom overlap with other conditions, varied aetiology, and often rapid and self‐resolving course. Aim To review comprehensively the literature regarding the pharmacological aetiologies of colonic ischaemia to enhance the understanding of the various mechanisms of disease, presentations, distribution, and outcomes. Methods A PubMed search for “colon ischaemia” and “ischaemic colitis” alone as well as in combination with various known pharmacologic causes was performed. Only the highest quality and relevant literature was included in this review. The quality of the literature for each association was rated by the authors and a consensus was made when discrepancies were encountered. Only associations that were deemed “moderate” or “strong” were included. Results The literature considering pharmacologically associated colonic ischaemia is diverse, lacks codification and is characterised by numerous case reports and case series. Constipation‐inducing drugs, digoxin, hormonal therapies, illicit drugs, immunomodulators, laxatives, and NSAIDs were strongly associated with colonic ischaemia. Antimicrobials, appetite suppressants, chemotherapies, decongestants, diuretics, ergot alkaloids, serotonin agents, statins, and vasopressor agents were moderately associated. Conclusions Patients presenting with abdominal pain, diarrhoea, or bloody stool need to be evaluated for the possibility of this condition and treated accordingly. Timely diagnosis is necessary to improve patient outcomes. This review aims to increase awareness among clinicians regarding the presentation of pharmacologically induced colonic ischaemia.
Sinus venosus atrial septal defect (SVASD) is a rare adult congenital heart disease which permits shunting of blood from the systemic to the pulmonary circulation and is commonly associated with anomalous pulmonary venous return.We report a case of a 27-year-old man with a history of premature birth and unilateral cryptorchidism who was admitted for syncope. Electrocardiogram (ECG) demonstrated atrial fibrillation (AF)and S1Q3T3 pattern along with an incomplete right bundle branch block. Transthoracic echocardiography (TTE) suggested the presence of right ventricular pressure and volume overload and severe right ventricular and right atrial enlargement. The agitated saline study was negative suggesting no inter-atrial communication. Transesophageal echocardiography (TEE) demonstrated a superior SVASD and raised the possibility of an anomalous pulmonary venous connection. Chest computed tomography identified the right superior pulmonary vein connection to the superior vena cava.The diagnosis of SVASD poses multiple challenges from the variety of symptoms to the selection of appropriate imaging and the complexity of surgical treatment.
Objectives:We aim to characterize the prevalence and impact of anxiety and depression (AD) in hospitalized patients with chronic pancreatitis (CP). Anxiety and depression have been shown to have a significant impact on mortality and length of stay in gastrointestinal diseases, but there are limited studies evaluating its impact on CP.Methods: We performed a retrospective analysis using the National Inpatient Sample from 2007 to 2014. The outcomes were the prevalence and trend of AD, impact on mortality, length of stay, and cost and independent predictors of AD.Results: A total of 75,744 patients with CP were included in our analysis, of which 23,323 (31%) had anxiety or depression. The prevalence of anxiety increased from 7.33% in 2007 to 20.02% in 2014. Depression increased from 18.49% in 2007 to 23.89% in 2014. Independent predictors of AD were decreasing age, female sex, and multiple comorbidities. Decreased risk was seen in African Americans, Hispanics, and those from the South and West. Anxiety and depression did not impact overall mortality or length of stay.Conclusions: Anxiety and depression are increasingly recognized diagnosis in patients with CP. Careful management and treatment of psychiatric illnesses and improving quality of life need to be addressed for these patients.
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