Mesenteric ischemia: Difference between revisions
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==Pathophysiology== | == Pathophysiology == | ||
4 distinct entities: | 4 distinct entities: | ||
#Mesenteric arterial embolism | |||
#Mesenteric arterial thrombosis | |||
#Nonocclusive mesenteric ischemia | |||
#Mesenteric venous thrombosis | |||
==Epidemiology== | == Epidemiology == | ||
*Mean age: 70yo | |||
*2/3 women | |||
==Risk Factors== | == Risk Factors == | ||
*CAD | |||
*Valvular heart disease | |||
*Dysrhythmia | |||
*Hypovolemia / hypotension | |||
*Meds | |||
*diuretic or vasoconstrictive meds, dig, dialysis | |||
== Si/Symptoms == | |||
Pain out of proportion to exam | Pain out of proportion to exam | ||
| Line 35: | Line 34: | ||
Severe, poorly localized, colicky | Severe, poorly localized, colicky | ||
== W/U == | |||
Lactate (higher later) | Lactate (higher later) | ||
| Line 46: | Line 44: | ||
Angiography | Angiography | ||
== Treatment == | |||
IV Abx | IV Abx | ||
| Line 57: | Line 54: | ||
Narcotic analgesia | Narcotic analgesia | ||
Acute arterial embolusPapaverine infusion (30-60 mg/h IV), surgical embolectomy, or intra-arterial thrombolysis | Acute arterial embolusPapaverine infusion (30-60 mg/h IV), surgical embolectomy, or intra-arterial thrombolysis | ||
Acute arterial thrombosisPapaverine infusion and | |||
Acute arterial thrombosisPapaverine infusion and arterial reconstruction either through aortosuperior mesenteric arterial bypass grafting or | |||
reimplantation of the SMA to the aorta | reimplantation of the SMA to the aorta | ||
Nonocclusive mesenteric ischemiaPapaverine infusion | 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. | |||
== Consultation == | |||
IR | IR | ||
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Surgery | Surgery | ||
== Source == | |||
6/06 MISTRY, Rosen's, Tintinalli | 6/06 MISTRY, Rosen's, Tintinalli | ||
<br/>[[Category:GI]]<br/><br/> | |||
[[Category:GI]] | |||
Revision as of 16:53, 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
- diuretic or vasoconstrictive meds, dig, dialysis
Si/Symptoms
Pain out of proportion to exam
Severe, poorly localized, colicky
W/U
Lactate (higher later)
CTA
Angiography
Treatment
IV Abx
IVF
Narcotic analgesia
Acute arterial embolusPapaverine infusion (30-60 mg/h IV), surgical embolectomy, or intra-arterial thrombolysis
Acute arterial thrombosisPapaverine infusion and arterial reconstruction either through aortosuperior mesenteric arterial bypass grafting or
reimplantation of the SMA to the aorta
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.
Consultation
IR
Vascular
Surgery
Source
6/06 MISTRY, Rosen's, Tintinalli