Ischemia of the Small Bowel

Question 1

2 types of ischemia of small bowel?

Answer 1

Mesenteric arterial occlusion

Non-occlusive perfusion insufficiency

Question 2

What is mesenteric arterial occlusion?

Answer 2

Hypoxia of the mucosa (most metabolically active)

The longer the hypoxia the more the damage and complication increase

Question 3

What causes MAO?

Answer 3

Mesenteric artery atherosclerosis (angiography)

Thromboembolism from heart

Question 4

How does MAO present

?

Answer 4

Chronic: angina of guts= result of atherosclerosis

• Abdo pain
• Vomiting
• Distended abdomen
• Absent bowel sounds

Question 5

Diagnosis of MAO?

Answer 5

• Pain out of proportion with clinical findings
• Acidosis on gases
• Lactate elevated
• CRP- normal
• WCC: slightly raised
• CT angiogram

Question 6

Treatment of MAO?

Answer 6

• Surgery to resect gangrenous bowel, fast intervention, re-anastomose bowel
• Prepare patient/family for worst

Question 7

Prognosis of MAO?

Answer 7

Length of ischaemia determines prognosis

Question 8

What can the MAO infarction develop into?

Answer 8

Mucosal infarction 
|
Mural infarction 
|
Transmural infarct + regeneration stricture/ gangrene

Question 9

Risk of Acute abdomen resection?

Answer 9

Short bowel syndrome

Question 10

What is non-occlusive perfusion insufficiency?

Answer 10

Hypoxia of mucosa where much of the tissue damage is after reperfusion

Question 11

What causes non-occlusive perfusion insufficiency?

Answer 11

Insufficient blood flow due to

• Shock
• Strangulation obstructing venous return (hernia, adhesion)
• Drugs (caffeine)
• Hyperviscosity

Question 12

How does non-occlusive perfusion insufficiency present?

Answer 12

Post-prandial abdominal pain

Wt loss