acute mesenteric ischaemia Flashcards Preview

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Flashcards in acute mesenteric ischaemia Deck (11)
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1
Q

what is acute mesenteric ischaemia?

A

the sudden decrease in blood supply to the bowel, resulting in bowel ischaemia and if not promptly treated, rapid gangrene and death

2
Q

what are the common causes of acute mesenteric ischaemia?

A
  • thrombus in situ (acute mesenteric arterial thrombosis) e.g atherosclerosis
  • embolism (acute mesenteric arterial embolism) e.g Cardiac causes/ Abdominal or thoracic aneurysm
  • non occlusive cause (non occlusive mesenteric ischaemia) e.g hypovolemic or cardiogenic shock
  • venous occlusion and congestion (mesenteric venous thrombosis) e.g coagulopathy, malignancy, inflammatory disorders
3
Q

what are the risk factors for acute mesenteric ischaemia?

A

depend on underlying cause

specifically for acute mesenteric arterial thrombosis, main reversible risk factors are

  • smoking
  • hyperlipidaemia
  • hypertension

other potential causes are

  • AF
  • intracardiac thrombus
  • thoracic aneurysm/ thrombus
4
Q

what are the clinical features of acute mesenteric ischaemia?

A
  • generalised abdominal pain out of proportion to clinical factors
  • diffused. constant pain
  • nausea an dvomitting
  • examination may be unremarkable and patient can’t localise pain
  • late stage ischaemia and necrosis can present as bowel perforation
  • take note of embolic sources e.g AF, heart murmurs, or signs of previous valvular replacement surgery
5
Q

what are the differentials for acute mesenteric ischaemia?

A
  • peptic ulcer disease
  • bowel obstruction
  • symptomatic AAA
6
Q

what lab tests are done for acute mesenteric ischaemia?

A
  • ABG to asses acidosis and serum lactate, secondary to bowel infarction
  • routine bloods (FBC, U&E, clotting, amylase, LFTs and group and save)

NB: As well as in pancreatitis, amylase also rises in mesenteric ischaemia, as well as ectopic pregnancy, bowel perforation and DKA

7
Q

what can cause a risk in amylase?

A

As well as in pancreatitis, amylase also rises in mesenteric ischaemia, as well as ectopic pregnancy, bowel perforation and DKA

8
Q

what imaging can be done for acute mesenteric ischaemia?

A
  • CT scan with IV contrast
  • arterial bowel ischaemia will show on CT imaging as an oedematous bowel, secondary to ischaemia and vasodilation, before progressing to loss of bowel wall enhancement and pneumatosis
  • suspicion of bowel perforation = erect CXR for evidence of perforation and CT abdomen with IV contrast

(avoid oral contrast in mesenteric ischaemia due to difficulty in assessing bowel wall enhancement)

9
Q

what is the initial management for acute mesenteric ischaemia?

A

a surgical emergency

requires urgent resuscitation and early senior involvement

  • IV fluids
  • catheter
  • fluid balance chart
  • broad spectrum antibiotics due to risk of faecal contamination in cases of perforation of the ischaemic or necrotic bowel and bacterial translocation
  • early ITU input due to significant acidosis
10
Q

what is the definitive management for mesenteric ischaemia?

A
  • excision of necrotic or non viable bowel if no viable revascularisation.
    Most patients will end up with a covering loop or end stoma.
  • revascularisation of the bowel. Removes thrombus via radiological intervention. Preferably done via angioplasty.
11
Q

what are the complications from acute mesenteric ischaemia?

A

bowel necrosis and perforation

post surgically, may get short gut syndrome,a malabsorption disorder caused by a lack of functional small intestine.