Mesenteric ischaemia and ischaemic colitis Flashcards Preview

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Flashcards in Mesenteric ischaemia and ischaemic colitis Deck (16):
1

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

2

Pathology/ aetiology of acute mesenteric ischaemia

May occur due to superior mesenteric artery embolism or thrombosis, mesenteric vein thrombosis or non occlusive disease.

Other causes:
Trauma, Vasculitis, Radiotherapy, Strangulation

3

Clinical presentation of acute mesenteric ischaemia?

Classical triad:
Acute severe abdominal pain (pain is constant and central OR around iliac fossa)

Rapid hypovolaemia--> Shock

No abdominal signs


4

Diagnostic tests and results for acute mesenteric ischaemia

Bloods: Raised Hb concentration due to plasma loss, WCC, raised plasma amylase

Persistant metabolic acidosis


5

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

6

Treatment for acute mesenteric ischaemia?

Fluid resuscitation
Abx- gentamicin + metronidazole
Heparin

Local thrombolysis via a catheter
Dead bowel is removed in surgery

7

How does heparin work?
Fondaparinux?

Activates antithrombin which inactivates factor 10a and prevents thrombin formation. Preventing conversion of fibrinogen to fibrin (preventing clot formation)

Fondaparinux only inhibits factor 10a

8

How does CHRONIC mesenteric ischaemia present?

(Rarely with history of vascular disease)

Triad:
Abdo pain (severe, colicky, post-prandial)
Weight loss
Upper abdo bruit

+ PR bleeding, malabsorption, vomitting, nausea

9

What tests would u do for chronic mesenteric ischaemia?

CT angiography/ Contrast enhanced MR angiography
Doppler USS

10

Treatment for chronic mesenteric ischaemia?

Surgery due to ongoing risk of infarction:

Percutaneous transluminal angioplasty and stent insertion
Or open revascularisation

11

What is ischaemic colitis?

Chronic colonic ischaemia

Due to reduced blood flow in inferior mesenteric artery

Ranges from mild ischaemia to gangrenous colitis

12

Presentation of ischaemic colitis?

Low left sided abdominal pain +- bloody diarrhoea

13

Tests for ischaemic colitis?

Colonoscopy + biopsy= gold standard

Also CT

Barium enema will show thumb printing in bowel if there is a sub mucosal swelling

14

Treatment for ischaemic colitis?

Conservative fluid replacement and antibiotics

Most recover but strictures are common

15

Gangrenous ischaemic colitis presentation?

Peritonitis and hypovolaemic shock

16

Gangrenous ischaemic colitis treatment?

Prompt resuscitation
Followed by surgical resection and stoma formation (colostomy bag)