Mesenteric Vascular Occlusion

Question 1

outline blood supply to gut

Answer 1

• foregut
  
  • Stomach, part of duodenum, biliary system, liver pancreas
  • coeliac artery
• midgut
  
  • duodenum–> first half of transverse colon
  • superior mesenteric artery
• hindgut
  
  • 2nd half of transverse colon–>rectum
  • inferior mesenteric artery

Question 2

aetiology?

Answer 2

occlusion of superior (rarely inferior) mesenteric vessels or one of its branches, due to:

• arterial embolism: AF
• arterial thrombosis: atherosclerosis etc
• venous thrombosis: portal HT

Question 3

epidemiology?

Answer 3

often older pts with cardiac history

Question 4

symptoms?

Answer 4

• sudden onset, severe pain out of proportion w clinical signs
• shock
• ocasionally passage of blood & mucus PR

Question 5

signs?

Answer 5

abdo tenderness and rigidity- mild initially but marked later on

Question 6

Ix?

Answer 6

• ABG
• CT angiogram

Question 7

Mx?

Answer 7

• fluid resus
• Abx
• surgery
  
  • laparotomy in early cases –> embolectomy

however, often will be a terminal life event in elderly (v poor prognosis)