intestinal ischemia Flashcards
4 types of intestinal ischemia:
I) Colonic ischemia
2) Chronic mesenteric ischemia
3) Acute mesenteric ischemia
4) Mesenteric venous thrombosis.
usually a sudden LLQ pain with an urge to defecate, followed by passage of red-to-maroon stool within 1 day
Colonic ischemia
Dx of colonic ischemia
Diagnose with colonoscopy if there are no signs of peritonitis. Also okay is sigmoidoscopy + gentle barium enema.
treatment of colonic ischemia
The usual treatment is bowel rest. fluids. and antibiotics.
What is “thumbprintinq,” and when is it seen?
Submucosal hemorrhage and edema is seen on KUB or BE as “thurnbprinting”
other name for Chronic mesenteric ischemia
intestinal angina.
Chronic mesenteric ischemia classic triad:
1) abdominal pain after meals
2) abdominal bruit
3) weight loss(from tolerating only smaller meals)
if abdominal pain out of proportion to any
physical findings
Suspect mesenteric vascular ischemia
Diagnosis of Chronic mesenteric ischemia
Diagnosis is based on symptoms and angiography (or MRI angiography) with evidence of occlusion in the splanchnic (intestinal) arteries.
treatment of intestinal angina
The only treatment is surgical bypass
These patients are acutely ill with vomiting, diarrhea, and occult blood. Bowel infarction leads to acidosis, increased SGOT (ALT), and elevated amylase
Acute mesenteric ischemia
Dx of Acute mesenteric ischemia
The abdominal exam may be fairly benign, leading to the erroneous diagnosis of acute gastroenteritis. Do angiography unless there are signs of perforation (e.g., acidosis, high amylase)in which case the patient goes directly to surgery for deadbowel resection and possible embolectomy
diagnostic procedure of choice for Mesenteric venous thrombosis (MVT)
CT
Treat acute MVT with
thrornbolytics and long-term anticoagulants
Treatment of chronic MVT
is focused on minimizing bleeding from varices with sclerotherapy, portosystemic shunts, or similar devices
