Intestinal ischaemia Flashcards
What can ischaemic bowel disease be classified into
acute mesenteric
chronic mesenteric
colonic ischaemia
What can acute mesenteric ischaemia be split into
embolic
thrombotic
venous mesenteric ischaemia
What is the most common type of ischaemia with the best prognosis
colonic ischaemia
What usually causes acute mesenteric ischaemia
embolism resulting in occlusion of an artery which supplies the small bowel - SMA
patients usually have a history of AF
What kind of features does chronic mesenteric ischaemia have
rare clinical diagnosis
has non-specific features and may be thought as intestinal angina
colicky intermittent abdominal pain occurs
What kind of features does acute mesenteric ischaemia have
abdominal pain is severe, of sudden onset and out of keeping with physical exam findings
What is ischaemic colitis
describes an acute but transient compromise in blood flow to large bowel
may lead to inflammation, ulceration and haemorrhage
Where is ischaemic colitis more likely to occur
in watershed areas - such as splenic flexure
places located at borders of territory supplied by IMA and SMA
What may a patient with intestinal ischemia present with
abdominal pain - out of proportion in AMI
abdominal tenderness-
early sign in colonic ischaemia, late sign in AMI
blood/mucus in stool
fever
weight loss in chronic mesenteric ischaemia
epigastric bruit ( murmurs heard over abdomen )
What are some risk factors for intestinal ischaemia
increasing age
Atrial fibrillation - particularly for mesenteric ischaemia
other emboli causes - endocarditis, malignancy
CVD risk factors- smoking , hypertension, diabetes
Cocaine - ischemic colitis seen in young patients following cocaine use
What investigations are required
CT scan with contrast/CT angiogram
Abdominal X -ray
– thumbprinting seen
FBC
ABG and lactate
-metabolic acidosis
What is the management for AMI
Immediate laparotomy - is signs of advanced ischemia
poor prognosis, especially if surgery is delayed
What is the management for ischaemic colitis
usually supportive
surgery may be required in minority of cases
Indications for surgery include -
peritonitis, perforation or ongoing haemorrhage
