Bowel ischaemia

Question 1

What are the 3 main types of bowel ischaemia?

Answer 1

1. Acute mesenteric ischaemia
2. Chronic mesenteric ischaemia
3. Chronic colonic ischaemia

Question 2

What feature + abdomen pan should make u consider mesenteric ischaemia?

Answer 2

Atrial fibrillation

Question 3

What part of the bowel is usually affected by acute mesenteric ischaemia?

Answer 3

small bowel

Question 4

What are the causes of acute mesenteric ischaemia?

Answer 4

superior mesenteric artery thrombosis or embolism 
non-occlusive disease - poor CO
trauma
vasculitis
radiotherapy
strangulation

Question 5

How does acute mesenteric ischaemia present?

Answer 5

classic triad of:
1. acute severe abdominal pain
2. no/minimal abdo signs
3. rapid hypovolaemia - shock
degree of illness far out of proportion w clinical signs

Question 6

What tests would u do with acute mesenteric ischaemia?

Answer 6

FBC - raised Hb (due to plasma loss) + WCC,
Raised plasma amylase
Persistent metabolic acidosis

Question 7

What are the complications of acute mesenteric ischaemia and how are they treated?

Answer 7

1. septic peritonitis
2. progression of SIRS to multi-organ failure due to bacterial translocation across dying gut wall
   Resuscitate w fluid, abx (tazocin), LMWH/heparin
   Remove dead bowel at surgery