Mesenteric ischeamia

Question 1

laparotomy

Answer 1

surgical procedure
large incision through the abd wall to access abd cavity

a.k.a celiotomy

Question 2

What almost always involved the small bowel?

Answer 2

acute mesenteric ischaemia

Question 3

what 3 things could acute mesenteric ischaemia follow?

Answer 3

1. SMA thrombosis
2. mesenteric vein thrombosis
3. non-occlusive disease

Question 4

triad of symptoms for acute mesenteric ischaemia

Answer 4

1. acute severe abd pain
2. no abd signs
3. rapid hypovolamia –> shock

pain tends to be constant, central or around RIF

Question 5

What would bloods show in acute mesenteric ischaemia?

Answer 5

Raised Hb (due to plasma loss)
WCC raised
Persistent metabolic acidosis

Question 6

Main life-threatening complications of acute mesenteric ischaemia?

Answer 6

1. septic peritonitis

2. progression a SIRS into a MODS (mediated by bacterial translation across dying gut wall)

Question 7

Tx acute mesenteric ischaemia

Answer 7

Resuscitation with fluid, antibiotics (gentamicin + metronidazole) and heparin

If angiography done, thrombolytics may be infused locally via catheter

dead bowel removed at surgery

? revasculariation on potentially viable bowel

Question 8

what is 95% of chronic mesenteric ischamia caused by?

Answer 8

diffuse atherosclerotic disease in all 3 mesenteric arteries

Question 9

whats chronic mesenteric ischamia a.k.a

Answer 9

intestinal angina

Question 10

Triad of presentation for intestinal angina

Answer 10

1. severe, colicky post-prandial abd pain ‘gut claudication’
2. decreased weight (eating hurts)
3. upper abd bruit may be present with PR bleeding, malab and N&V

Question 11

Dx tests for intestinal angina

Answer 11

Ct angiography

Doppler USS

Question 12

Tx intestinal angina

Answer 12

Surgery (due to risk of acute infarction)

Percutaneous transluminal angioplasty + stent insertion