Mesenteric ischemia: Difference between revisions
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== Pathophysiology == | ==Background== | ||
=== Pathophysiology === | |||
4 distinct entities: | 4 distinct entities: | ||
#Mesenteric arterial embolism | #Mesenteric arterial embolism | ||
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#Mesenteric venous thrombosis | #Mesenteric venous thrombosis | ||
== Epidemiology == | === Epidemiology === | ||
#Mean age: 70yo | #Mean age: 70yo | ||
#2/3 women | #2/3 women | ||
== Risk Factors == | ===Risk Factors=== | ||
#CAD | #CAD | ||
#Valvular heart disease | #[[Valvular heart disease[[ | ||
#Dysrhythmia | #[[Dysrhythmia]] | ||
#Hypovolemia / hypotension | #Hypovolemia / [[hypotension]] | ||
#Meds | #Meds | ||
## Diuretics | ## Diuretics | ||
| Line 21: | Line 22: | ||
# Dialysis | # Dialysis | ||
== Signs/Symptoms == | ==Diagnosis== | ||
===Signs/Symptoms=== | |||
# Pain out of proportion to exam | # Pain out of proportion to exam | ||
# Severe, poorly localized, colicky | # Severe, poorly localized, colicky | ||
| Line 27: | Line 29: | ||
==Work Up== | ==Work Up== | ||
#Labs | #Labs | ||
##Lactate (higher later) | ##[[Lactate]] (higher later) | ||
##WBC (often >15K) | ##WBC (often >15K) | ||
##Chemistry (metabolic acidosis) | ##Chemistry (metabolic acidosis) | ||
#CTA | #CTA | ||
#Angiography | #Angiography | ||
==Differential Diagnosis== | |||
===Diffuse [[Abdominal Pain]]=== | |||
{{Template:Abdominal Pain DDX Diffuse}} | |||
== Treatment == | == Treatment == | ||
| Line 54: | Line 60: | ||
# Angioplasty with or without stent placement or surgical revascularization | # Angioplasty with or without stent placement or surgical revascularization | ||
== | ==Disposition== | ||
*Admit with consultation of one or more of the following | |||
**IR | |||
**Vascular | |||
**Surgery | |||
== Source == | == Source == | ||
*Rosen's | |||
*Tintinalli | |||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 03:49, 27 October 2014
Background
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
Diagnosis
Signs/Symptoms
- Pain out of proportion to exam
- Severe, poorly localized, colicky
Work Up
- Labs
- Lactate (higher later)
- WBC (often >15K)
- Chemistry (metabolic acidosis)
- CTA
- Angiography
Differential Diagnosis
Diffuse Abdominal Pain
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
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
Disposition
- Admit with consultation of one or more of the following
- IR
- Vascular
- Surgery
Source
- Rosen's
- Tintinalli