Difference between revisions of "Mesenteric ischemia"
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=== Pathophysiology === | === Pathophysiology === | ||
4 distinct entities: | 4 distinct entities: | ||
− | #Mesenteric arterial embolism | + | #Mesenteric arterial embolism (ex. Afib) |
− | #Mesenteric arterial thrombosis | + | #Mesenteric arterial thrombosis (ex. Vasculopath) |
− | #Nonocclusive mesenteric ischemia | + | #Nonocclusive mesenteric ischemia (ex. Hypovolemia from diuretics) |
− | #Mesenteric venous thrombosis | + | #Mesenteric venous thrombosis (ex. hypercoagulable state) |
=== Epidemiology === | === Epidemiology === |
Revision as of 15:42, 8 January 2015
Contents
Background
Pathophysiology
4 distinct entities:
- Mesenteric arterial embolism (ex. Afib)
- Mesenteric arterial thrombosis (ex. Vasculopath)
- Nonocclusive mesenteric ischemia (ex. Hypovolemia from diuretics)
- Mesenteric venous thrombosis (ex. hypercoagulable state)
Epidemiology
- Mean age: 70yo
- 2/3 women
Risk Factors
- CAD
- [[Valvular heart disease[[
- Dysrhythmia
- Hypovolemia / hypotension
- Meds
- Diuretics
- Vasoconstrictive
- Digoxin
- Dialysis
Diagnosis
Signs/Symptoms
- Pain out of proportion to exam
- Severe, poorly localized, colicky
Work Up
- Labs
- Lactate (higher later)
- WBC (often >15K)
- Chemistry (metabolic acidosis)
- CTA
- Mesentaric angiography considered gold standard
Differential Diagnosis
Diffuse Abdominal Pain
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Gastroparesis
- Diabetic ketoacidosis
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
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
Disposition
- Admit with consultation of one or more of the following
- IR
- Vascular
- Surgery
Source
- Rosen's
- Tintinalli