Difference between revisions of "Mesenteric ischemia"

m (Rossdonaldson1 moved page Mesenteric Ischemia to Mesenteric ischemia)
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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
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# 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
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==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 ==
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# Angioplasty with or without stent placement or surgical revascularization
 
# Angioplasty with or without stent placement or surgical revascularization
  
== Consultation ==
+
==Disposition==
# IR
+
*Admit with consultation of one or more of the following
# Vascular
+
**IR
# Surgery
+
**Vascular
 +
**Surgery
  
 
== Source ==
 
== Source ==
6/06 MISTRY, Rosen's, Tintinalli
+
*Rosen's
 +
*Tintinalli
  
 
[[Category:GI]]
 
[[Category:GI]]

Revision as of 03:49, 27 October 2014

Background

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

Diagnosis

Signs/Symptoms

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

Work Up

  1. Labs
    1. Lactate (higher later)
    2. WBC (often >15K)
    3. Chemistry (metabolic acidosis)
  2. CTA
  3. Angiography

Differential Diagnosis

Diffuse Abdominal Pain

Diffuse Abdominal pain

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

Disposition

  • Admit with consultation of one or more of the following
    • IR
    • Vascular
    • Surgery

Source

  • Rosen's
  • Tintinalli