Difference between revisions of "Mesenteric ischemia"

(Differential Diagnosis)
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* Dialysis
 
* Dialysis
  
==Diagnosis==
+
==Clinical Features==
===Signs/Symptoms===
 
 
* Pain out of proportion to exam. Abdomen often soft, without guarding.  
 
* Pain out of proportion to exam. Abdomen often soft, without guarding.  
 
* Severe, generalized, colicky
 
* Severe, generalized, colicky
  
==Work Up==
+
==Differential Diagnosis==
 +
{{Colitis types}}
 +
 
 +
{{Abdominal Pain DDX Diffuse}}
 +
 
 +
==Diagnosis==
 
*Labs
 
*Labs
 
**[[Lactate]] (higher later)
 
**[[Lactate]] (higher later)
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*Mesentaric angiography considered gold standard
 
*Mesentaric angiography considered gold standard
  
==Differential Diagnosis==
+
==Management==
{{Colitis types}}
 
 
 
{{Abdominal Pain DDX Diffuse}}
 
 
 
== Treatment ==
 
 
* [[IVF]]
 
* [[IVF]]
 
* IV [[antibiotics]]
 
* IV [[antibiotics]]
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**Surgery
 
**Surgery
  
== Source ==
+
==References==
*Rosen's
 
*Tintinalli
 
  
 
[[Category:GI]]
 
[[Category:GI]]

Revision as of 19:09, 11 May 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
  • Atherosclerotic Disease
Venous Thrombosis
  • Prior thrombosis history
  • Hypercoagulable state (preg, cancer, clotting disorder)
Nonocculsive
  • Hypovolemic state
  • Heart Failure
  • Diuretic use

Epidemiology

  • Mean age: 70yo
  • 2/3 women

Risk Factors

Clinical Features

  • Pain out of proportion to exam. Abdomen often soft, without guarding.
  • Severe, generalized, colicky

Differential Diagnosis

Colitis

Diffuse Abdominal pain

Diagnosis

  • Labs
    • Lactate (higher later)
    • WBC (often >15K)
    • Chemistry (metabolic acidosis)
  • CTA
  • Mesentaric angiography considered gold standard

Management

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

  1. Angioplasty with or without stent placement or surgical revascularization

Disposition

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

References