Intestinal ischaemia Flashcards
Define intestinal ischaemia
Obstruction of a mesenteric vessel leading to bowel ischaemia & necrosis
Aetiology of intestinal ischaemia
2 + can be a consequence of 4
Embolus - 60%
Thrombosis - 40%
Can be a consequence of: Volvulus Interssusception Bowel strangulation Failed surgical resection
Area most vulnerable to intestinal ischaemia
“Watershed zone” = area between supply of superior & inferior mesenteric arteries near splenic flexure
Risk factors for intestinal ischaemia
4
AF
Endocarditis
Arterial thrombosis
Venous thrombosis
Causes of arterial thrombosis
4
hypercholesterolaemia
hypertension
diabetes mellitus
smoking
Causes of venous thrombosis
5
portal hypertension splenectomy septic thrombophlebitis OCP thrombophilia
Epidemiology of intestinal ischaemia
prevalence, age
UNCOMMON
More common in elderly
Presenting symptoms of intestinal ischaemia
6
Severe acute colicky abdominal pain Vomiting Rectal bleeding History of chronic mesenteric artery insufficiency gross weight loss post prandial abdominal pain History of heart or liver disease
Signs of intestinal ischaemia on physical examination
5
Diffuse abdominal tenderness Abdominal distention Tender palatable mass (ischaemic bowel) Bowel sounds may be absent Disproportionate degree of cardiovascular collapse
Investigations for intestinal ischaemia
general + 3
Diagnosis based on clinical suspicion or after a laparotomy
AXR
Bloods
Mesenteric angiography
Investigations for intestinal ischaemia - AXR
1
Thickening of small bowel folds & signs of obstruction
Investigations for intestinal ischaemia - bloods
6
ABG - lactic acidosis FBC U&Es LFTs Clotting Cross match
Investigations for intestinal ischaemia - mesenteric angiography
(1)
Only if stable
