Acute Mesenteric Ischemia

Under an acute mesenteric ischemia refers to the disruption of intestinal blood flow by an embolism, thrombosis or a condition with a slow flow rate. It leads to the release of mediators, inflammatory response and ultimately infarction. The abdominal pain is much stronger than suggested by the physical examination findings. Other imaging techniques are often positive in later stages of the disease. Early rapid diagnosis is difficult, but angiography and exploratory laparotomy have the greatest sensitivity. Sometimes treatment with vasodilators is successful. The treatment consists in an embolectomy, revascularization of vital segments or resection. Mortality is high.

Under an acute mesenteric ischemia refers to the disruption of intestinal blood flow by an embolism, thrombosis or a condition with a slow flow rate. It leads to the release of mediators, inflammatory response and ultimately infarction. The abdominal pain is much stronger than suggested by the physical examination findings. Other imaging techniques are often positive in later stages of the disease. Early rapid diagnosis is difficult, but angiography and exploratory laparotomy have the greatest sensitivity. Sometimes treatment with vasodilators is successful. The treatment consists in an embolectomy, revascularization of vital segments or resection. Mortality is high. Pathophysiology The intestinal mucosa is very metabolically active, so well supplied with blood (up to 20-25% of the heart volume usually) and therefore extremely vulnerable is of decreased perfusion. Ischemia destroys the mucosal barrier, allowing the passage of bacteria, toxins and vasoactive mediators, which in turn lead to myocardial damage, as a systemic inflammatory syndrome (sepsis and septic shock), multiple organ failure and death. The release of mediators can occur before a complete infarction. Necrosis is usually already 10-12 h after the onset of symptoms. Etiology Three major vessels supply the abdominal cavity: the celiac trunk: supplies the esophagus, the stomach, the proximal duodenum, the liver, the gall bladder, the pancreas and the spleen superior mesenteric artery: supplies the distal duodenum, the jejunum, the ileum and the colon to the left Flexus inferior mesenteric artery: supplies the descending colon, the sigmoid colon and the rectum. In these areas rarely ischemia developed. There are numerous collateral vessels in the stomach, duodenum and rectum. The splenic flexure is located on the “divide” between the upper and lower mesenteric artery and is therefore particularly ischämiegefährdet. It should be noted that acute mesenteric ischemia of ischemic colitis (ischemic colitis) is different, includes only small vessels and mainly caused mucosal and bleeding. Blood flow in Mesenterialgebiet can be interrupted in both the venous and arterial leg. Patients> 50 years have the highest risk of closure types and risk factors are listed in causes of acute mesenteric ischemia. However, many patients have no identifiable risk factors. Causes of acute mesenteric ischemia closure type risk factors Arterial embolism (> 40%) coronary sclerosis, heart failure, valvular heart disease, atrial fibrillation, history of arterial embolism Arterial thrombosis (30%) Generalized atherosclerosis vein thrombosis (15%) hypercoagulable, inflammatory processes (eg. As pancreatitis , diverticulitis), trauma, heart failure, renal failure, portal hypertension, reduction of blood pressure Non-occlusive ischemia (15%) states with low flow rate (heart failure, circulatory shock, cardiopulmonary bypass), vasoconstriction in the splanchnic (vasopressors, cocaine) Symptoms and complaints The earliest signs of mesenteric ischemia is severe pain with minimal physical findings. The abdomen remains soft with little or no pain. Possibly. is a mild tachycardia present. Only later with the development of necrosis signs of peritonitis occurred (Acute abdomen pain: peritonitis) on with strong abdominal pain, strained abdominal wall, guarding and lack of bowel sounds. The chair can heme-positive (increased likelihood of increasing ischemia). It develop the signs of circulatory shock, and the disease often leads to death. A sudden onset of pain is suspicious but not diagnostic of an arterial embolism, while a more gradual development of pain is typical of venous thrombosis. Patients with a history of postprandial abdominal pain (indicating an intestinal angina) may have an arterial thrombosis. Diagnosis The clinical diagnosis is more important than diagnostic testing procedures mesenteric angiography or CT angiography in unclear diagnosis Early diagnosis is important because mortality increases significantly if it’s something that intestinal infarction occurred. Mesenteric ischemia must in every patient> 50 years with known risk factors or predisposing diseases, indicating a sudden severe abdominal pain should be considered. Mesenteric ischemia figure provided by Parswa Ansari, M.D. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/mesenteric_ischemia_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/mesenteric_ischemia_high_de.jpg?la = en & thn = 0 ‘, title:’ mesenteric ischemia ‘description:’ u003Ca id = “v38395125 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eDer arrow points to the superior mesenteric artery with an abrupt termination of the IV administered contrast agent. Links in the abdomen is visible thickening of the small intestine. This embolus comes from the heart of a patient with atrial fibrillation u003c / p u003e u003c / div u003e ‘credits’. Figure provided by Parswa Ansari

Health Life Media Team

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