INTERNAL MEDICINE EXIMIUS

MESENTERIC VASCULAR INSUFFICIENCY 2021

MICHAEL RAZOTE, MD

• Occurs when splanchnic perfusion fails to meet the metabolic

demands of the intestine

CLASSIFICATION
1. arterioocclusive mesenteric ischemia
2. nonocclusive mesenteric ischemia
3. mesenteric venous thombosis
RISK FACTORS:
1. atrial fibrillation
2. Recent MI
3. VHD
4. Recent cardiac or vascular catheterization
5. 5.Old age
6. Ascvd
7. High-dose vasopressor
8. cardiogenic/septic shock
9. Cocaine overdose
10. Cardiovascular surgery
11. Hypercoagulable state (protein C/S def, antithrombin III
def, PV, carcinoma)
ANATOMY AND PHYSIOLOGY

ACUTE

 Splanchnic circulation receives 30% of cardiac output

 Extensive collateralization to prevent ischemic injury
 Autoregulation of blood flow
 Increase oxygen extraction from the blood
 Common location of ischemia in colon: MESENTERIC ISCHEMIA
1. griffith’s point  Severe, acute, nonremitting abdominal pain strikingly out
2. Sudeck’s point of proportion to PE findings
 Nausea, vomiting, diarrhea, anorexia and bloody stool
PRESENTATION, EVALUATION, AND MANAGEMENT  Minimal abdominal distention and hypoactive bowel
 Mortality rate >50% sounds which later demonstrate peritonitis and
 Significant indicator of survival is timeliness of dx and cardiovascular collapse
treatment.  Cbc, serum chem, coag. profile, ABGs, amylase, lipase,
lactic acid, blood typing, imaging
 Admission for resuscitation and surgery referrral
 Ecg – arrhythmia/recent MI
 Plain abdominal x-ray – pneumoperitoneum,
thumbprinting, and pneumatosis intestinalis
 CT angiography
• Mesenteric angiography
• Mesenteric duplex scan
• Endoscopy
• Embolectomy by arteriotomy
• Thrombolysis
• Angioplasty and stent placement
• Artery bypass

TRANSCRIBERS Group5 1
 INTERNAL MEDICINE EXIMIUS
MESENTERIC VASCULAR INSUFFICIENCY 2021
MICHAEL RAZOTE, MD
• Resection of compromised intestine
MESENTERIC VENOUS THROMBOSIS
 Gradual or sudden onset of vague abdominal pain, nausea,
and vomiting
 Abominal distention withn mild to moderate tenderness and
signs of dehydration
 Abdominal spiral ct with iv and oral contrast
 Fluid resuscitation, antibiotics, anticoagulation, and
resection.
CHRONIC INTESTINAL ISCHEMIA
 Presents with postprandial abdominal pain
 Food fear
 Weight loss and chronic diarrhea
 Malnourished patient and presence of abdominal
bruitmesenteric duplex utz and mesenteric angiography
 Medical management of ascvd
 Angioplasty and stenting
 endartectomy and bypass

NONOCCLUSIVE MESENTERIC ISCHEMIA

 Abdominal pain, anorexia, bloody stool, and abdominal
distention
 Most patients are obtunded
 Leukocytosis, metabolic acidodis, elevated amylase and
cpk, lacctic acidosis
 D-dimer
 Admisssion to icu and agressive fluid resuscitation,
oxygenation, blood transfusion, empiric antibiotic therapy
 Monitoring of vs, uo, abgs, and lactate
 Vasoconstrictors should be avoided

• Laparotomy
• Resection of bowel and stoma formation

TRANSCRIBERS Group5 2