Mesenteric ischamia Flashcards
Types of bowel ischaemia
Acute mesenteric ischaemia
Chronic mesenteric ischaemia
Chronic colonic ischaemia
Acute mesenteric ischaemia causes
Superior mesenteric artery (thromboembolism)
Non-occlusive
Mesenteric vein thrombosis
Non occlusive cause of mesenteric ischaemia
low flow state such as poor cardiac output
Sx of acute mesenteric ischaemia
Triad:
acute severe abdo pain
no abdo signs
rapid hypovolaemia->shock
Acute mesenteric ischaemia AXR
gas less abdo
Gold standard for dx of acute mesenteric ischaemia
Arteriography
MR/CT arteriography (less invasive)
Mostly dx during laprotomy finding of a necrotic bowel
New emerging tools to dx mesentric ischaemia
Measurement of mucosal oxygen tension
MR oximetric measurements of superior mesenteric vein flow
Main complications of acute mesenteric ischaemia
Septic peritonitis
SIRS -> Multi-organ dysfunction syndrome (MOD)
Rx of acute mesenteric ischaemia
Fluids + Abx (gent +met)
Heparin
Revascularisation/resection of necrotic bowel
Which part of bowel does acute mesenteric ischaemia affect
always small bowel +/- other parts
Chronic mesenteric ischaemia sx
Triad
Post-prandial (eating) colicky abdo pain
wt loss (eating hurts)
upper abdo bruit
Causes of chronic mesenteric ischaemia
atheroma + low flow state
Ix for chronic mesenteric ischaemia
CT/MR angiography
Chronic mesenteric ischaemia aka
intestinal angina
Rx of chronic mesenteric ischaemia
Due to risk of infarct, elective percutanous transluminal angioplasty + stent
(or open revascularisation)
