MESENTERIC ISCHEMIA

Question 1

Clinical Features

Answer 1

Abdominal Pain
Pain out of proportion with physical findings

Bloody stools are a late finding

+/- N/V, diarrhea, AMS, shock

Question 2

Risk Factors

Answer 2

Elderly
Vascular Disease
Hypercoagulable States

Question 3

Investigations

Answer 3

Lactate - low sensitivity

CTA (Sn 93.3%, Sp 95.9%)

Question 4

Management: Stable - SMA thrombus or embolism, MVT, NOMI

Answer 4

SMA Thrombus or Embolism: EVT

MVT: Anticoagulate. unfractionated heparin IV bolus of 80 units/kg (max 5,000 units) followed by continuous infusion at 18 units/kg/h with a goal activated partial thromboplastin time of 60-85 s (1.5-2 times control).

NOMI: Intra-arterial vasodilators

Question 5

Management: Peritonitis - SMA thrombus or embolism, MVT, NOMI

Answer 5

Piperacillin-tazobactam 4.5 g IV q8h

Immediate Surgical Consult

SMA thrombus or
embolism: Embolectomy and urgent surgery

MVT:
Bowel Necrosis - OR
No Bowel Necrosis - EVT or tPA

NOMI: OR

NOMI:

Question 6

Management: Unstable

Answer 6

Emergent General Surgery Consult

OR