Intestinal Ischaemia Flashcards
Define Intestinal Ischaemia?
Obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis
What is the aetiology of Intestinal Ischaemia?
Embolus (60%)
Thrombosis (40%)
What can Intestinal Ischaemia be a consequence of?
Volvulus
Intussusception
Bowel strangulation
Failed surgical resection
What are the risk factors for Intestinal Ischaemia?
AF
Endocarditis (can throw emboli)
Arterial Thrombosis
Venous Thrombosis
What are some examples of Arterial Thrombosis?
Hypercholesterolaemia
Hypertension
DM
Smoking
What are some examples of Venous Thrombosis?
Portal hypertension Splenectomy Septic Thrombophlebitis OCP Thrombophilia
What is the epidemiology of Intestinal Ischaemia?
Uncommon
More common in the ELDERLY
What are the presenting symptoms of Intestinal Ischaemia?
Severe acute colicky abdominal pain Vomiting Rectal bleeding History of chronic mesenteric artery insufficiency History of heart or liver disease
What are some of the symptoms caused by a history of chronic mesenteric artery insufficiency?
Gross weight loss
Post-prandial abdominal pain
What are the signs of Intestinal Ischaemia on physical examination?
Diffuse abdominal tenderness Abdominal distension Tender palpable mass (ischaemic bowel) Bowel sounds may be absent Disproportionate degree of cardiovascular collapse
What investigations for Intestinal Ischaemia?
AXR
Bloods
Mesenteric Angiography
Why do we do an AXR for Intestinal Ischaemia?
Thickening of small bowel folds and signs of obstruction
What bloods do we do for Intestinal Ischaemia?
ABG - lactic acidosis FBC U&Es LFTs Clotting Cross-match
When do we do a Mesenteric Angiography for Intestinal Ischaemia?
Only if stable
What is diagnosis for Intestinal Ischaemia based on?
Clinical suspicion or after laparotomy
