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Bowel Ischaemia: Acute mesenteric ischaemia (Treatment (IV heparin,…
Bowel Ischaemia: Acute mesenteric ischaemia
Prognosis
This will be septic peritonitis
Treatment
IV heparin
Surgery
FLuid
Gentamicin and metronidazole
Types of Bowel ischaemia: One is acute mesenteric ischaemia, chronic mesenteric (intestinal angina) ischaemia and ischaemia colitis
Watershed areas in the splenic flexure and the caecum are the most affected by ischaemia
Blood supply is by the inferior and superior mesenteric artery
IF YOU SEE ATRIAL FIBRILLATION AND BOWEL PAIN. THINK MESENTERIC ISCHAEMIA
Definition: bowel ischaemia is a condition that involves the bowel not getting enough blood to it. Thus, meaning that the bowel doesn't get enough oxygen and nutrients
Epidemiology
Almost always involves the small bowel
Old people >50
Causes
A superior mesenteric artery embolism. This can be due to AF
Mesenteric vein thromboiss. Tends to be in younger patients
MOST COMMON: is a superior mesenteric atery thrombosis
Non-occlusive disease. This happens when there is a low flow state that reflects poor cardiac output
Diagnosis
Abdominal Xray: will see a gas less abdomen
Laparotomy: this is a procedure that cuts into the abdomial wall. Looks for necrotisisng bowel
Bloods: raised Hb and Raised WBC. Has Metabolic acidosis. Because of the shallow breathing. And this is due to the pressure of hypovolaemia on the kidneys
CT/MRI angiography
CLINCIAL PRESENTATION
Classic Triad: severe abdominal pain. This is central and can present in the right iliac fossa
Rapid hypovolaemia: this is presented by a rapid pulse, pale skin and a reduced urine output
No abdominal signs