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

Background

Pathophysiology

4 distinct entities:

  1. Mesenteric arterial embolism (ex. Afib)
  2. Mesenteric arterial thrombosis (ex. Vasculopath)
  3. Nonocclusive mesenteric ischemia (ex. Hypovolemia from diuretics)
  4. Mesenteric venous thrombosis (ex. hypercoagulable state)

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. Mesentaric angiography considered gold standard

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