Mesenteric ischemia: Difference between revisions

Revision as of 16:58, 12 March 2011

Pathophysiology

4 distinct entities:

Mesenteric arterial embolism
Mesenteric arterial thrombosis
Nonocclusive mesenteric ischemia
Mesenteric venous thrombosis

Epidemiology

Mean age: 70yo
2/3 women

Risk Factors

CAD
Valvular heart disease
Dysrhythmia
Hypovolemia / hypotension
Meds
- Diuretics
- Vasoconstrictive
- Digoxin
Dialysis

Signs/Symptoms

Pain out of proportion to exam
Severe, poorly localized, colicky

W/U

Lactate (higher later)
CTA
Angiography

Treatment

IVF
IV Abx
Narcotic analgesia

Acute arterial embolus

Papaverine infusion (30-60 mg/h IV) OR
surgical embolectomy OR
intra-arterial thrombolysis

Nonocclusive mesenteric ischemia

Papaverine infusion

Mesenteric venous thrombosis

Heparin/warfarin either alone or in combination with surgery
Immediate heparinization should be started even when surgical intervention is indicated
- Decreases progression of thrombosis and improves survival

Chronic mesenteric ischemia

Angioplasty with or without stent placement or surgical revascularization

Consultation

IR
Vascular
Surgery

Source

6/06 MISTRY, Rosen's, Tintinalli

Authors:

@@ Line 14: / Line 14: @@
 *Mean age: 70yo
 *2/3 women
 == Risk Factors ==
@@ Line 24: / Line 22: @@
 *Hypovolemia / hypotension
 *Meds
-*diuretic or vasoconstrictive meds, dig, dialysis
+** Diuretics
+** Vasoconstrictive
+** Digoxin
+* Dialysis
-== Si/Symptoms ==
-Pain out of proportion to exam
-Severe, poorly localized, colicky
+== Signs/Symptoms ==
+* Pain out of proportion to exam
+* Severe, poorly localized, colicky
 == W/U ==
-Lactate (higher later)
+* Lactate (higher later)
+* CTA
-CTA
+* Angiography
-Angiography
 == Treatment ==
-IV Abx
+* IVF
+* IV Abx
-IVF
+* Narcotic analgesia
-Narcotic analgesia
-Acute arterial embolusPapaverine infusion (30-60 mg/h IV), surgical embolectomy, or intra-arterial thrombolysis
+Acute arterial embolus
+* Papaverine infusion (30-60 mg/h IV) OR
+* surgical embolectomy OR
+* intra-arterial thrombolysis
+Nonocclusive mesenteric ischemia
+* Papaverine infusion
-Acute arterial thrombosisPapaverine infusion and arterial reconstruction either through aortosuperior mesenteric arterial bypass grafting or
+Mesenteric venous thrombosis
+* Heparin/warfarin either alone or in combination with surgery
-reimplantation of the SMA to the aorta
+* Immediate heparinization should be started even when surgical intervention is indicated
+** Decreases progression of thrombosis and improves survival
-Nonocclusive mesenteric ischemiaPapaverine infusion
-Mesenteric venous thrombosisAnticoagulation with heparin/warfarin either alone or in combination with surgery. Immediate heparinization should be started even when surgical intervention is indicated, as it decreases progression of thrombosis and improves survival
-Chronic mesenteric ischemiaAngioplasty with or without stent placement or surgical revascularization.
+Chronic mesenteric ischemia
+* Angioplasty with or without stent placement or surgical revascularization
 == Consultation ==
-IR
+* IR
+* Vascular
-Vascular
+* Surgery
-Surgery
 == Source ==