Mesenteric Ischaemia or Infarction Flashcards

1
Q

Ischaemia to the lower gastrointestinal tract can result in a variety of clinical conditions.

What are the common predisposing factors in bowel ischaemia?

A
  • increasing age
  • AF → particularly for mesenteric ischaemia
  • other causes of emboli: endocarditis, malignancy
  • cardiovascular disease risk factors → smoking, HTN, DM
  • cocaine → ischaemic colitis is sometimes seen in young pts following cocaine use
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2
Q

What are common features of bowel ischaemia?

A
  • abdominal pain - in acute mesenteric ischaemia this is often sudden + severe and out-of-keeping with physical exam findings
  • rectal bleeding
  • diarrhoea
  • fever
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3
Q

What investigations are done for bowel ischaemia?

A
  • WBC → elevated
  • Lactic acidosis
  • CT first-line
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4
Q

Acute mesenteric ischaemia is typically caused by an embolism resulting in occlusion of an artery which supplies the small bowel, for example the superior mesenteric artery. Classically patients have a history of atrial fibrillation. The abdominal pain is typically severe, of sudden onset and out-of-keeping with physical exam findings.

What is the management of acute mesenteric ischaemia?

A
  • urgent surgery is usually required
  • poor prognosis, esp if surgery delayed
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5
Q

What are important causes of bowel infarction?

A
  • strangulating bowel obstruction
  • occlusion of mesenteric artery by an embolus
  • occlusion of mesenteric artery by a thrombus
  • occlusion of mesenteric artery by an aortic dissection extending into mesenteric artery
  • compression of veins in bowel wall (due to bowel obstruction)
  • occlusion of a mesenteric vein by thrombus
  • vasculitis
  • non-occlusive infarction eg. shock
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6
Q

Where might thromboemboli originate from?

A
  • left atrium in a pt w/ atrial fib
  • mural thrombus secondary to MI
  • a vegetation on a heart valve in a pt w/ infective endocarditis
  • an atheromatous plaque in aorta which ruptures
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7
Q

Bowel infarction is difficult to recognise clinically and so clinicians must have a high index of suspicion and actively consider the diagnosis. What are the classical clinical symptoms?

A
  • acute colicky abdominal pain
  • rectal bleeding
  • shock (due to associated blood loss)
  • maybe abdo pain
  • signs of peritonism
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8
Q

What is the management of bowel infarction?

A
  • resusciated w/ IV fluids
  • given broad spectrum antibiotics
  • urgent laparotomy where any dead bowel resected
  • revascularisation by embolectomy or bypass may improve doubtfully viable bowel and allow primary anastomosis
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9
Q

What are the differences between mesenteric ischaemia and ischaemic colitis?

A
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