Ischemic Bowel Disease

Question 1

4 Major causes of Acute Mesenteric Ischemia

Answer 1

SMA embolism—50%
SMA thrombosis—15-25% (Often superimposed on patients w/ progressive atherosclerotic disease, or w/ trauma or infection
Nonocclusive ischemia—20-30%
Mesenteric venous thrombosis—5%

Question 2

Messenteric Ischemia Hallmarks of clinical presentation

Answer 2

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

Question 3

Acute Messenteric Ischemia Clinical Presentation

Answer 3

Abdominal exam may be normal initially
Occult blood in stool
As bowel ischemia worsens:
Abdominal distention
Absent bowel sounds
Peritoneal signs
\+/- feculant odor to the breath

Question 4

Summary of the etiology of acute mesenteric ischemia

Answer 4

Arterial emboli: Atrial fibrillation, MI
Arterial thrombosis: Atherosclerotic disease
Venous thrombosis: Underlying disorder in coagulation (hypercoagulable), neoplasm
Nonocculsive mesenteric ischemia: Low flow states (shock)

Question 5

Most common finding in ischemic colitis, colonic infaction and venous occlusion
on CT

Answer 5

Bowel wall thickening

Question 6

MAE: Mesenteric Angiography/Treatment

Answer 6

Surgery & embolectomy; or local infusion of thrombolytic therapy (NOT systemic, is at site of embolism only)

Question 7

MAT: Mesenteric Angiography/Treatment

Answer 7

Surgery w/ thrombectomy + revascularization or heparinization

Question 8

MVT: Mesenteric Angiography/Treatment

Answer 8

heparinization + resection of infarcted bowel