Difference between revisions of "Mesenteric ischemia"

(Risk Factors)
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===Risk Factors===
 
===Risk Factors===
 
#CAD
 
#CAD
#[[Valvular heart disease[[
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#[[Valvular heart disease]]
 
#[[Dysrhythmia]]
 
#[[Dysrhythmia]]
 
#Hypovolemia / [[hypotension]]
 
#Hypovolemia / [[hypotension]]

Revision as of 13:19, 3 February 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)
Risk Factors for Mesenteric Ischemia Types
Type Risk Factor
Arterial Embolism
  • Dysrhythmia (A. Fib)
  • Valve Disease
  • MI
Arterial Thrombosis
  • Athrosclerotic Disease
Venous Thrombosis
  • Prior thrombosis history
  • Hypercoagulable state (preg, cancer, clotting disorder)
Nonocculsive
  • Hypovolemic state
  • Heart Failure
  • Diuretic use

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