Difference between revisions of "Mesenteric ischemia"

Line 1: Line 1:
 
== Pathophysiology ==
 
== Pathophysiology ==
 
 
4 distinct entities:
 
4 distinct entities:
 
 
#Mesenteric arterial embolism
 
#Mesenteric arterial embolism
 
#Mesenteric arterial thrombosis
 
#Mesenteric arterial thrombosis
 
#Nonocclusive mesenteric ischemia
 
#Nonocclusive mesenteric ischemia
 
#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
+
## Vasoconstrictive
** Vasoconstrictive
+
## Digoxin
** Digoxin
+
# Dialysis
* Dialysis
 
  
 
== Signs/Symptoms ==
 
== Signs/Symptoms ==
 +
# Pain out of proportion to exam
 +
# Severe, poorly localized, colicky
  
* Pain out of proportion to exam
+
==Work Up==
* Severe, poorly localized, colicky
+
# Lactate (higher later)
 
+
# CTA
== W/U ==
+
# Angiography
 
 
* Lactate (higher later)
 
* CTA
 
* Angiography
 
  
 
== Treatment ==
 
== Treatment ==
 +
# IVF
 +
# IV Abx
 +
# Narcotic analgesia
  
* IVF
+
===Acute arterial embolus===
* IV Abx
+
# Papaverine infusion (30-60 mg/h IV) OR
* Narcotic analgesia
+
# surgical embolectomy OR
 +
# intra-arterial thrombolysis
  
Acute arterial embolus
+
===Nonocclusive mesenteric ischemia===
* Papaverine infusion (30-60 mg/h IV) OR
+
# Papaverine infusion
* surgical embolectomy OR
 
* intra-arterial thrombolysis
 
  
Nonocclusive mesenteric ischemia
+
===Mesenteric venous thrombosis===
* Papaverine infusion
+
# 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
  
Mesenteric venous thrombosis
+
===Chronic mesenteric ischemia===
* Heparin/warfarin either alone or in combination with surgery
+
# Angioplasty with or without stent placement or surgical revascularization
* 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 ==
 
== Consultation ==
 
+
# IR
* IR
+
# Vascular
* Vascular
+
# Surgery
* Surgery
 
  
 
== Source ==
 
== Source ==
 
 
6/06 MISTRY, Rosen's, Tintinalli
 
6/06 MISTRY, Rosen's, Tintinalli
  
<br/>[[Category:GI]]<br/><br/>
+
[[Category:GI]]

Revision as of 12:09, 14 March 2011

Pathophysiology

4 distinct entities:

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

Epidemiology

  1. Mean age: 70yo
  2. 2/3 women

Risk Factors

  1. CAD
  2. Valvular heart disease
  3. Dysrhythmia
  4. Hypovolemia / hypotension
  5. Meds
    1. Diuretics
    2. Vasoconstrictive
    3. Digoxin
  6. Dialysis

Signs/Symptoms

  1. Pain out of proportion to exam
  2. Severe, poorly localized, colicky

Work Up

  1. Lactate (higher later)
  2. CTA
  3. Angiography

Treatment

  1. IVF
  2. IV Abx
  3. Narcotic analgesia

Acute arterial embolus

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

Nonocclusive mesenteric ischemia

  1. Papaverine infusion

Mesenteric venous thrombosis

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

Chronic mesenteric ischemia

  1. Angioplasty with or without stent placement or surgical revascularization

Consultation

  1. IR
  2. Vascular
  3. Surgery

Source

6/06 MISTRY, Rosen's, Tintinalli