Flashcards in Mesenteric ischaemia and ischaemic colitis Deck (16):
What is acute mesenteric ischaemia?
Acute mesenteric ischaemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischaemia and eventual gangrene of the bowel wall
Generally effects small bowel
Pathology/ aetiology of acute mesenteric ischaemia
May occur due to superior mesenteric artery embolism or thrombosis, mesenteric vein thrombosis or non occlusive disease.
Trauma, Vasculitis, Radiotherapy, Strangulation
Clinical presentation of acute mesenteric ischaemia?
Acute severe abdominal pain (pain is constant and central OR around iliac fossa)
Rapid hypovolaemia--> Shock
No abdominal signs
Diagnostic tests and results for acute mesenteric ischaemia
Bloods: Raised Hb concentration due to plasma loss, WCC, raised plasma amylase
Persistant metabolic acidosis
Severe complications of acute mesenteric ischaemia?
Septic peritonitis: progression of septic inflammatory response syndrome into multi organ response syndrome
Mediated by bacterial translocation across the dying gut wall
Treatment for acute mesenteric ischaemia?
Abx- gentamicin + metronidazole
Local thrombolysis via a catheter
Dead bowel is removed in surgery
How does heparin work?
Activates antithrombin which inactivates factor 10a and prevents thrombin formation. Preventing conversion of fibrinogen to fibrin (preventing clot formation)
Fondaparinux only inhibits factor 10a
How does CHRONIC mesenteric ischaemia present?
(Rarely with history of vascular disease)
Abdo pain (severe, colicky, post-prandial)
Upper abdo bruit
+ PR bleeding, malabsorption, vomitting, nausea
What tests would u do for chronic mesenteric ischaemia?
CT angiography/ Contrast enhanced MR angiography
Treatment for chronic mesenteric ischaemia?
Surgery due to ongoing risk of infarction:
Percutaneous transluminal angioplasty and stent insertion
Or open revascularisation
What is ischaemic colitis?
Chronic colonic ischaemia
Due to reduced blood flow in inferior mesenteric artery
Ranges from mild ischaemia to gangrenous colitis
Presentation of ischaemic colitis?
Low left sided abdominal pain +- bloody diarrhoea
Tests for ischaemic colitis?
Colonoscopy + biopsy= gold standard
Barium enema will show thumb printing in bowel if there is a sub mucosal swelling
Treatment for ischaemic colitis?
Conservative fluid replacement and antibiotics
Most recover but strictures are common
Gangrenous ischaemic colitis presentation?
Peritonitis and hypovolaemic shock