acute mesenteric ischemia

Bowel ischemia   Cellular damage Bowel necrosi s Sudden interruption of blood supply to segment of intestine Rare (0.09-0.2%) but life threatening (50-80% mortality) Embolism (AMAE50%) Occlusive Thrombosis (AMAT-1525%) AMI Non-occlusive Venous thrombosis (MVT-5-15%) ACUTE MESENTRIC ARTERIAL Sources of embolism: EMBOLISM Left atrium-cardiac arrythmia Left ventricle-global myocardial dysfunction with poor EF Endocarditis ACUTE MESENTRIC ARTERIAL •THROMBOSIS Pre existing chronic atherosclerosis •SMA thrombosis •Takes time to progress critical obstruction MESENTRIC VENOUS < 1% cases of MI THROMBOSIS         Severe pain abdomen – 95% Nausea –44% Vomiting – 35% Diarrhoea – 35% Bleeding per rectum – 16% Triad of pain + fever + blood in stools – 1/3rd patients Signs of peritonitis – irreversible bowel ischemia with necrosis Delayed presentation – septic shock  High index of suspicion  Metabolic acidosis with in cases with clinical features  Elevated lactates >2 mmol/L  These cases should undergo early CT angiography  D-Dimer: >0.9 mg/L, reflecting ongoing clot formation & fibrinolysis ctCT Bowel wall thickening CT  Should possible be done in any suspected case as soon as  Irreversible bowel  Dilated bowel ischemia:  Pneumatosis intestinalis  Portal venous gas  Free intraperitoneal gas  At the time of  Fluid and electrolyte resuscitation diagnosis:  Naso-gastric suction  Broad spectrum antibiotics  Heparin therapy  Vasopressors: used with caution, dobutamine, low dose dopamine and milrinone cause less impact on mesenteric blood flow  Continued monitoring of lactates  Prompt laparotomy in unstable, perforation peritonitis cases  Goal of  Re-establishment blood supply to the ischemic surgery: bowel  Resection of all non-viable regions  Preservation of all viable bowel ... thrombosis (MVT-5-15%) ACUTE MESENTRIC ARTERIAL Sources of embolism: EMBOLISM Left atrium-cardiac arrythmia Left ventricle-global myocardial dysfunction with poor EF Endocarditis ACUTE MESENTRIC ARTERIAL...Bowel ischemia   Cellular damage Bowel necrosi s Sudden interruption of blood supply to segment of intestine... Triad of pain + fever + blood in stools – 1/3rd patients Signs of peritonitis – irreversible bowel ischemia with necrosis Delayed presentation – septic shock  High index of suspicion  Metabolic