Chapter 136 - Mesenteric venous thrombosis

Question 1

Conditions associated with mesenteric venous thrombosis

Answer 1

BOX 136.1

Question 2

Mesenteric venous thrombosis first defined by

Answer 2

Warren and Eberhard 1935

Question 3

Epidemiology of MVT

Answer 3

middle aged to elderly equal gender distribution

Question 4

Percentage of MVT in patients with acute mesenteric ischemia

Answer 4

16%

Question 5

Mesenteric venous thrombosis that results in bowel gangrene

Answer 5

33-45%

Question 6

Mesenteric thrombosis found on laparotomy mortality rate

Answer 6

30%

Question 7

Mesenteric vs portal vein thrombosis

Answer 7

Mesenteric has much worse outcome

Question 8

Portal vein thrombosis rate of asymptomatic and intestinal infarction

Answer 8

Asymptomatic 61% Intestinal infarction 0-10%

Question 9

Rate of intestinal infarction in MVT

Answer 9

94%

Question 10

MVT intestinal infarction differ from arterial infarction

Answer 10

MVT = segmental ischemia, edema, swelling, reddish discolor arterial infarction = extensive ischemia, patchy cyanosis, reddish black discolor, no pulse

Question 11

Temporal classification of MVT

Answer 11

Acute < 4 weeks 71-74% Chronic > 4 weeks

Question 12

MVT diagnosis on history and physical

Answer 12

1) abdominal pain 2) nausea vomiting 3) LGIB 20% 4) elevated CRP

Question 13

MVT treatment

Answer 13

1) anticoagulation 2) fasting 3) NG tube 4) fluid resuscitation 5) replace lytes 6) analgesic 7) TPN 8) antibiotics 9) endovascular 10) thrombolysis 11) surgical open repair

Question 14

Recanalization rate and mortality rate after MVT treatment

Answer 14

91% recanalization 30 day mortality 12%

Question 15

Benefit of heparin over LMWH

Answer 15

1) greater anti-inflammatory effect 2) can be reversed quickly for surgery

Question 16

Dabigatran MOA

Answer 16

Thrombin inhibitor

Question 17

Reversal agent for dabigatran

Answer 17

idarucizumab

Question 18

In hospital mortality of MVT and 5 year survival

Answer 18

20% death 70% 5 year survival

Question 19

Endovascular treatment techniques for MVT

Answer 19

1) transjugular intrahepatic portosystemic shunting (TIPS) 2) mechanical aspiration thrombectomy 3) direct thrombolysis 4) percutaneous transhepatic mechanical thrombectomy 5) percutaneous transhepatic thrombolysis 6) thrombolysis via SMA 7) thrombolysis via operatively place mesenteric catheter

Question 20

Median length of bowel resection in MVT

Answer 20

0.6m (range 0.1-2.2m)

Question 21

Algorithm for MVT treatment

Answer 21

FIGURE 136.7