Mesenteric ischemia

Revision as of 16:58, 12 March 2011 by Jswartz (talk | contribs)

Pathophysiology

4 distinct entities:

  1. Mesenteric arterial embolism
  2. Mesenteric arterial thrombosis
  3. Nonocclusive mesenteric ischemia
  4. 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

W/U

  • 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