intestinal ischemia

Question 1

definition of intestinal ischemia

Answer 1

obstruction (eg by embolus/thrombosis) of a mesentaric vessel = ischemia and necrosis

Question 2

aetiology of intestinal ischemia

Answer 2

embolus (60%) arterial thrombosis (25%), venous thrombosis (15%)

from volvulus, intussusception, bowel strangulation within hernia, or failed surgical resection

Question 3

RF for intestinal ischemia

Answer 3

afib, mural thrombus and endocarditis for emboli

hypercholesterolaemia, HTN, DM, and smoking for arterial thrombosis

portal hypertension, splenectomy, septic thrombophelbitis, external compression of superior mesenteric vessels and cardiac failure for venous thrombosis

venous thrombosis - OCP users and thrombophilic conditions

Question 4

pathology for intestinal ischemia

Answer 4

occlusion of mesenteric vessels = acute bowel ischemia = infarction if not relieved with oedema and haemorrhage into bowel wall, lumen, peritoneal cavity

gangrene and bowel perf commonly develop

Question 5

epidemiology of intestinal ischemia

Answer 5

uncommon

more common on older people

Question 6

sx of intestinal ischemia

Answer 6

severe acute abdo colicky pain

associated nausea vom

history of chronic mesenteric artery insufficiency eg gross weight loss and abdo pain after eating

history of heart or liver disease

Question 7

signs of intestinal ischemia

Answer 7

diffuse abdo tenderness and abdo distension

tender palpable mass (ischemic bowel) maybe - especially if hernia

absent bowel sounds

disproportionate degree of CVS collapse

Question 8

Ix of intestinal ischemia

Answer 8

diagnosis difficult - either clinical suspicion/laparotomy

AXR - thickening of small bowel folds, and gas appearing in the bowel wall - late signs

bloods - ABG (lactic acidosis), FBC, UE, LFT, clotting, Xmatch

mesenteric arteriography: if stable, allows localisation, a measure of the extent of involvement and a trial of intervention