Ischemic Bowel

Question 1

4 causes of acute mesenteric ischemia

Answer 1

SMA embolism - 50%
SMA thrombosis - 15-25%
Nonocclusive ischemia - 20-30%
Mesenteric venous thrombosis - 5%

Question 2

Ischemic bowel hallmark pain

Answer 2

Severe cramping abd pain out of proportion to physical findings, poorly localized.

Question 3

Ischemic bowel S/S

Answer 3

Sudden or gradual
Prior episode
N/V/Bloody D

Question 4

Mesenteric Arterial Embolism (MAE)

Answer 4

Median age 70, women>men

Superior often involved, affects jejenum

Question 5

MAE prognosis

Answer 5

More favorable than SMA thrombosis

Question 6

Mesenenteric Arterial Thrombosis (MAT) etiology

Answer 6

Atherosclerosis
Trauma
Infection

Question 7

MAT origin of blackage

Answer 7

SMA or celiac axis

Symptoms don’t develop until significant blockage

Question 8

Mesenteric Venous Thrombosis (MVT)

Answer 8

Younger pop: 48-60
Acute or insidious
Usually secondary
Causes include portal vein thrombosis or hernia

Question 9

MVT S/S

Answer 9

Longer symptom presentation
Diffuse pain becoming constant
Anorexia, vomiting, diarrhea, constipation
Hematemesis

Question 10

MVT risks

Answer 10

Hypercoagulable state (common)
Portal HTN
Abd infxns
Trauma

Question 11

Nonocclusive mesenteric ischemia

Answer 11

Splanchnic hypoperfusion
CHF, MI, sepsis
High mortality

Question 12

Nonocclusive mesenteric ischemia S/S

Answer 12

Progressive abd pain
Bloating, N/V
AMS

Question 13

Ischemic bowel labs

Answer 13

Increased HCT. amylase, phos.
Increased serum lactate is increased most of the time.
Metabolic acidosis

Question 14

Pneumatosis Intestinalis

Answer 14

Gas cysts in the bowel, but not in the lumen.

Suggestive of necrotizing entercolitis

Question 15

CT scan

Answer 15

With contrast may show bowel wall thickening.

Question 16

Which med relieves mesenteric vasoconstriction?

Answer 16

Papaverine

Used in non-occlusive dz

Question 17

MVT tx

Answer 17

Heparinization and resection of infarcted bowel