Mesenteric ischemia: Difference between revisions
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== Pathophysiology == | == Pathophysiology == | ||
4 distinct entities: | 4 distinct entities: | ||
#Mesenteric arterial embolism | #Mesenteric arterial embolism | ||
#Mesenteric arterial thrombosis | #Mesenteric arterial thrombosis | ||
#Nonocclusive mesenteric ischemia | #Nonocclusive mesenteric ischemia | ||
#Mesenteric venous thrombosis | #Mesenteric venous thrombosis | ||
== Epidemiology == | == Epidemiology == | ||
#Mean age: 70yo | |||
#2/3 women | |||
== Risk Factors == | == Risk Factors == | ||
#CAD | |||
#Valvular heart disease | |||
#Dysrhythmia | |||
#Hypovolemia / hypotension | |||
#Meds | |||
## Diuretics | |||
## Vasoconstrictive | |||
## Digoxin | |||
# Dialysis | |||
== Signs/Symptoms == | == Signs/Symptoms == | ||
# Pain out of proportion to exam | |||
# Severe, poorly localized, colicky | |||
==Work Up== | |||
# Lactate (higher later) | |||
# CTA | |||
== | # Angiography | ||
== Treatment == | == 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 | |||
Chronic mesenteric ischemia | |||
== Consultation == | == Consultation == | ||
# IR | |||
# Vascular | |||
# Surgery | |||
== Source == | == Source == | ||
6/06 MISTRY, Rosen's, Tintinalli | 6/06 MISTRY, Rosen's, Tintinalli | ||
[[Category:GI]] |
Revision as of 12:09, 14 March 2011
Pathophysiology
4 distinct entities:
- Mesenteric arterial embolism
- Mesenteric arterial thrombosis
- Nonocclusive mesenteric ischemia
- Mesenteric venous thrombosis
Epidemiology
- Mean age: 70yo
- 2/3 women
Risk Factors
- CAD
- Valvular heart disease
- Dysrhythmia
- Hypovolemia / hypotension
- Meds
- Diuretics
- Vasoconstrictive
- Digoxin
- Dialysis
Signs/Symptoms
- Pain out of proportion to exam
- Severe, poorly localized, colicky
Work Up
- Lactate (higher later)
- CTA
- Angiography
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
Consultation
- IR
- Vascular
- Surgery
Source
6/06 MISTRY, Rosen's, Tintinalli