Difference between revisions of "Mesenteric ischemia"

Line 14: Line 14:
 
*Mean age: 70yo
 
*Mean age: 70yo
 
*2/3 women
 
*2/3 women
 
 
  
 
== Risk Factors ==
 
== Risk Factors ==
Line 24: Line 22:
 
*Hypovolemia / hypotension
 
*Hypovolemia / hypotension
 
*Meds
 
*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 ==
 
== W/U ==
  
Lactate (higher later)
+
* Lactate (higher later)
 
+
* CTA
CTA
+
* Angiography
 
 
Angiography
 
 
 
 
 
  
 
== Treatment ==
 
== 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 ==
 
== Consultation ==
  
IR
+
* IR
 
+
* Vascular
Vascular
+
* Surgery
 
 
Surgery
 
 
 
 
 
 
 
 
 
  
 
== Source ==
 
== Source ==

Revision as of 16:58, 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
    • 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