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Mesenteric Ischaemia (Chronic Colonic Ischaemia (Treatment (Fluid…
Mesenteric Ischaemia
Chronic Colonic Ischaemia
Symptoms:
lower left sided
abdominal pain + blood diarrhoea
Investigations
CT
Colonoscopy + biopsy = gold standard
Ranges from mild ischaemia to gangrenous colitis
Treatment
Fluid replacement
Antibiotics
Most recover but strictures are common
=Ischaemic colitis
Gangrenous ischaemic colitis
Prompt resuscitation is needed, followed by resection + stoma formation
Mortality is high
Presents with peritonitis and hypovolaemic shock
Tends to follow inferior mesenteric artery thrombosis
Acute Mesenteric Ischaemia
Symptoms
Classical clinical triad
No abdominal signs
Rapid hypovolaemia (because bowel does not absorb water anymore) and then shock
Acute severe abdominal pain
Pain tends to be constant around
RIF
Investigations
Raised WCC + raised plasma amylase
Persistent metabolic acidosis
Raised Hb due to plasma loss
Abdominal x-ray shows gasless abdomen early on
Laparotomy discovers necrotic bowel
Aetiology
Vasculitis
Radiotherapy
Trauma
Strangulation
Atheroma
Treatment
Heparin
Dead bowel is removed at surgery
Antibiotics e.g. gentamicin
Local thrombolysis via catheter
Fluid resuscitation
Features
Almost always involves small bowel
Normally follows superior mesenteric artery thrombosis, mesenteric vein thrombosis or non-occlusive disease
Usually reflects poor cardiac output
Complications
Progression of systemic inflammatory response syndrome into multi organ failure. This is mediated by bacterial translocation across the dying gut wall
Prognosis is poor for arterial thrombosis and non-occlusive disease and better for venous + embolic ischaemia
Septic peritonitis
Chronic Mesenteric Ischaemia
Pathophysiology: brought about by a low flow state with atheroma
Investigations
CT angiography
Symptoms
Triad
Weight loss
Upper abdominal bruit (murmur)
Severe colicky post-prandial abdominal pain
PR bleeding
Vomiting
Treatment
Surgery should be done due to ongoing risk of infarction
Percutaneous transluminal angioplasty + stent inversion or open revascularisation
= Mesenteric angina. Rare and difficult to diagnose
There are 3 types of bowel ischaemia