Acute mesenteric ischaemia Flashcards
What is acute mesenteric ischaemia?
Sudden decrease in blood supply to the bowel, resulting in bowel ischaemia leading to gangrene and bowel death
What are the 4 common causes of acute mesenteric ischaemia?
Acute mesenteric arterial thrombosis (atherosclerosis) Acute mesenteric arterial emobolism, non occlusive mesenteric ischaemia (shock) Mesenteric venous thrombosis (coagulopathy, malignancy)
What are the risk factors for acute mesenteric ischaemia?
reversible risk factors such as smoking, hyperlipidaemia, hypertension, chronic mesenteric ischaemia
What are the clinical features of acute mesenteric ischaemia?
generalised abdominal pain out of proportion to the clinical findings, diffuse and constant pain, nausea and vomiting, examination unremarkable, look for embolic sources
What are the differential diagnosis for acute mesenteric ischaemia?
peptic ulcer disease, bowel obstruction, symptomatic AAA
What investigations would be done for acute mesenteric ischaemia?
arterial blood gas to look at acidosis and lactate, FBC, Uand E, clotting, amylase (can raise in this), LFTs (if coeliac trunk is affected will cause derangement)
What imaging would be done for acute mesenteric ischaemia?
CT scan with IV contrast, will show oedematous bowel then ischaemia and vasodilation, loss of bowel wall enhancement and pneumatosis, can then do an erect CXR
What is the initial management for acute mesenteric ischaemia?
surgical emergency so urgent resuscitation, IV fluids, catheters, broad spectrum antibiotics due to faecal contamination, early ITU
What is the definitive management for acute mesenteric ischaemia?
excision of necrotic or non viable bowel, revascularisation of the bowel
What are the complications of acute mesenteric ischaemia?
bowel necrosis and perforation, mortality is around 50-80%, if survive may have short gut syndrome
