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Flashcards in Ischemic Bowel Disease Deck (30):
1

what are the 4 major causes of acute mesenteric ischemia?

SMA embolism, SMA thrombosis, nonocclusive ischemia, and mesenteric venous thrombosis

2

Why is superior mesenteric artery commonly involved with ischemic bowel disease?

due to it's angle off of the aorta

3

Causes mesenteric (arterial) vasoconstriction and venous dilation. Reduces portal venous pressure in patients bleeding from portal hypertension

vasopressin

4

Hallmark of mesenteric arterial embolism

Severe cramping abdominal pain, out of proportion of physical findings, poorly localized

5

Where are the common origins of mesenteric arterial emboli?

Thrombus from L atrium, L ventricle or cardiac valves

6

Is coagualopathy associated with mesenteric arterial thrombosis?

no, this is more common a culprit in venous thrombosis patients

7

What is the usual site of blockage for mesenteric arterial thrombosis?

SMA or celiac axis

8

Affects younger popn (48-60). Thrombosis of superior mesenteric vein or intestinal strangulation from hernia or volvulus

mesenteric venous thrombosis

9

What is different about the presentation of mesenteric venous thrombois compared to mesenteric arterial thrombosis?

longer symptom presentation-Pain diffuse and nonspecific initially, but later becomes constant

10

Major risk factor for mesenteric venous thrombosis

hypercoagulable states (75%)

11

What is the etiology of nonocclusive mesenteric ischemia?

Result of splanchnic hypoperfusion & vasoconstriction

12

What is a major risk factor for nonocclusive mesenteric ischemia?

atherosclerotic disease

13

Mortality associated with nonocclusive mesenteric ischemia

70%

14

Any patient with abdominal pain and metabolic acidosis has what condition until proven otherwise?

intestinal ischemia

15

Critically important lab for intestinal ischemia

elevated serum lactate

16

What might be present on a plain film in patients with mesenteric ischemia?

air fluid levels, dilated bowel loops, gasless abdomen

17

Gas cysts in the bowel wall. Suggestive of necrotizing enterocolitis

Pneumatosis intestinalis

18

Accumulation of gas in the portal vein and it’s branches. A variety of causes such as ischemic bowel, intra-abdominal sepsis

portal venous gas

19

First step in the evaluation of the acute abdomen

plain abdominal xrays

20

What is the preferred imaging study in the evaluation of the acute abdomen?

CT scan

21

What is necessary for evaluatio of the mucosal thickening of the bowel wall?

oral contrast

22

What can obscure the view of mesenteric vessel of a CT angiogram?

oral contrast

23

Good study for evaluation of suspected intestinal ischemia but don’t do if planning on percutaneous angiography too (excessive contrast with 2 studies)

CT angiography

24

Better at diagnosing venous occlusions

MR angiography

25

If diagnosis is fairly certain and need consideration for percutaneous treatment or for surgical planning. Can’t be used for venous occlusions

mesenteric percutaneous arteriography

26

Vasopressors that have less effect on mesentary

dobutamine, low dose dopamine, milrinone

27

What can be given at angiography directly to relieve mesentaric vasoconstriction?

papaverine

28

Gold standard diagnostic study for acute arterial ischemia

Mesenteric Angiography

29

Treatment includes : Papaverine infusion during angiography. Reverse underlying conditions. Repeat angiography can be done in 24 hrs. Surgical exploration reserved for patients with peritoneal signs

Nonocclusive mesenteric ischemia

30

Intestinal angina. Episodic or constant intestinal hypoperfusion. Secondary to atherosclerosis. Strongly associated with meals

Chronic mesenteric ischemia