Intestinal Ischaemia Flashcards
What is Ischaemic Colitis?
Most common form of intestinal ischaemia characterized by intestinal ischaemia.
What causes Ischaemic Colitis?
Caused by a decrease in intestinal blood flow due to small vessel occlusion or hypoperfusion.
Where is hypoperfusion most common in Ischaemic Colitis?
Most common in splenic flexors and recto-sigmoid junction.
What are the consequences of decreased intestinal perfusion?
Injury to colon mucosa, prolonged hypoperfusion resulting in transmural ischaemia, fulminant gangrene, perforation, peritonitis.
What are the risk factors for Ischaemic Colitis?
- Hypertension
- Diabetes Mellitus
- Atrial Fibrillation
- Aortic surgery
What is a common symptom of Ischaemic Colitis?
Severe abdominal pain, cramps, rapidly developing, located in the LLQ.
What is tenesmus?
A feeling of incomplete bowel evacuation.
What type of diarrhea is associated with Ischaemic Colitis?
Bloody diarrhea within 24 hours of abdominal pain.
What signs might be present on examination for Ischaemic Colitis?
- Shock: hypotension, tachycardia
- Peritonitis: rebound pain, rigidity, guarding
What is the management for unstable patients with Ischaemic Colitis?
Follow ABCDE protocol.
What imaging is used for differential diagnosis in Ischaemic Colitis?
X-RAY or CT to rule out bowel dilation, perforation, peritonitis.
What are indications for surgery in Ischaemic Colitis?
Presence of pneumatosis coli, portal gas, or pneumoperitoneum.
What supportive care is provided for Ischaemic Colitis?
- IV fluids
- Empiric, broad-spectrum antibiotics
- Bowel rest
- Haemodynamic monitoring
What is a critical imaging finding in end-stage ischaemia/necrosis?
Pneumatosis coli, portal gas, or pneumoperitoneum.
What is the treatment if a patient with Ischaemic Colitis does not improve?
Surgical consult and laparotomy.
What is Acute Mesenteric Ischaemia (AMI)?
Sudden loss or decrease of blood flow in the mesenteric vasculature leading to infarction or necrosis.
What are the types of Acute Mesenteric Ischaemia?
- Arterial Occlusion
- Venous Occlusion
- Non-occlusive arterial vasospasm
What are the risk factors for Acute Mesenteric Ischaemia?
- Atrial Fibrillation
- Prior Myocardial Infarction
- Diabetes Mellitus
- Hypertension
- Hypercoagulable disorder
- Cancer
- Smoking
- Oral constipation
- Clot history
What complications can arise from Acute Mesenteric Ischaemia?
- Bowel necrosis
- Perforation
- Sepsis/Peritonitis
What are common symptoms of Acute Mesenteric Ischaemia?
- Sudden onset of severe abdominal pain
- Nausea/Vomiting
- Diarrhea
- Bloody stool
What signs may indicate Acute Mesenteric Ischaemia?
- Abdominal distention
- Diffuse abdominal tenderness, rebound, guarding
- Tachycardia and hypotension
What does ‘pain out of proportion to physical examination’ indicate?
It may suggest Acute Mesenteric Ischaemia.
What is the management for stable patients with Acute Mesenteric Ischaemia?
Focused history and examination.
What imaging techniques are used in Acute Mesenteric Ischaemia?
- Abdominal X-RAY
- CT/CTA
What does a CT scan show in mesenteric venous thrombosis?
- Thrombus in portal veins
- Venous congestion in SMV or IMV
- End tissue oedema
What does a CT scan reveal in arterial occlusion?
Diffuse luminal narrowing of SMA and atherosclerotic disease.
What is the treatment for non-occlusive mesenteric ischemia?
- Acute: Vasodilators, Anticoagulants
- Long-term: Oral anticoagulants, treat underlying condition, modify risks
What is the treatment for venous occlusion in Acute Mesenteric Ischaemia?
- Anticoagulant - IV heparin
- Assess for underlying hypercoagulable state
- Further testing for thrombophilia
- Consult surgery for thrombolysis/thrombectomy
What is the treatment for arterial occlusion in Acute Mesenteric Ischaemia?
- Anticoagulant - IV heparin
- Identify source of emboli
- Surgery consult for thrombolysis, thrombectomy, embolectomy, exploratory laparotomy
