Difference between revisions of "Mesenteric ischemia"

(Created page with "==Pathophysiology== 4 distinct entities: 1. Mesenteric arterial embolism 2. Mesenteric arterial thrombosis 3. Nonocclusive mesenteric ischemia 4. Mesenteric venous thrombos...")
 
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==Pathophysiology==
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== Pathophysiology ==
 
 
  
 
4 distinct entities:
 
4 distinct entities:
  
1. Mesenteric arterial embolism
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#Mesenteric arterial embolism
 
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#Mesenteric arterial thrombosis
2. Mesenteric arterial thrombosis
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#Nonocclusive mesenteric ischemia
 
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#Mesenteric venous thrombosis
3. Nonocclusive mesenteric ischemia
 
  
4. Mesenteric venous thrombosis
 
  
 
  
==Epidemiology==
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== Epidemiology ==
  
 +
*Mean age: 70yo
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*2/3 women
  
Mean age: 70yo; 2/3 women
 
  
 
  
==Risk Factors==
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== Risk Factors ==
  
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*CAD
 +
*Valvular heart disease
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*Dysrhythmia
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*Hypovolemia / hypotension
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*Meds
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*diuretic or vasoconstrictive meds, dig, dialysis
  
CAD, valvular heart disease, dysrhythmia, hypovolemia or hypotension, diuretic or vasoconstrictive meds, dig, dialysis
 
  
 
 
==Si/Symptoms==
 
  
 +
== Si/Symptoms ==
  
 
Pain out of proportion to exam
 
Pain out of proportion to exam
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Severe, poorly localized, colicky
 
Severe, poorly localized, colicky
  
 
  
==W/U==
 
  
 +
== W/U ==
  
 
Lactate (higher later)
 
Lactate (higher later)
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Angiography
 
Angiography
  
 
  
==Treatment==
 
  
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== Treatment ==
  
 
IV Abx
 
IV Abx
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Narcotic analgesia
 
Narcotic analgesia
  
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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 arterial reconstruction either through aortosuperior mesenteric arterial bypass grafting or
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 +
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
 
  
+
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==
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Chronic mesenteric ischemiaAngioplasty with or without stent placement or surgical revascularization.
  
 +
 +
 +
== Consultation ==
  
 
IR
 
IR
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Surgery
 
Surgery
  
 
  
 
  
==Source ==
 
  
 +
 +
== Source ==
  
 
6/06 MISTRY, Rosen's, Tintinalli
 
6/06 MISTRY, Rosen's, Tintinalli
  
 
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<br/>[[Category:GI]]<br/><br/>
 
 
 
 
[[Category:GI]]
 

Revision as of 16:53, 12 March 2011

Pathophysiology

4 distinct entities:

  1. Mesenteric arterial embolism
  2. Mesenteric arterial thrombosis
  3. Nonocclusive mesenteric ischemia
  4. 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