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Acute Mesenteric Ischaemia (Treatment (COMPLICATIONS (Septic peritonitis,…
Acute Mesenteric Ischaemia
Epidemiology
Usually seen in those over 50
Almost always involves the small bowel
Causes
Superior mesenteric artery embolism
Mesenteric vein thrombosis
Superior mesenteric artery thrombus - COMMONEST CAUSE
Non-occlusive disease
Clinical Presentation
Classical clinical TRIAD
No abdominal signs
Rapid hypovolaemia resulting in shock - pale skin, weak rapid pulse, reduced urine output, confusion
Acute severe abdominal pain - tends to be constant, central or around the right iliac fossa
The degree of illness is often far out of proportion with clinical signs
Diagnosis
Abdominal X-ray - used to rule out other pathology, see gases abdomen
Laparotomy - to make diagnosis, may see necrotic bowel if not treated quickly
Bloods - raised Hb due to plasma loss, raised white cell count, persistent METABOLIC ACIDOSIS
CT/MRI angiography
Provides non-invasive alternative to simple arteriography
Treatment
IV heparin to reduce clotting
Surgery to remove the dead bowel
Antibiotics e.g. IV gentamicin
COMPLICATIONS
Septic peritonitis
Systemic inflammatory response syndrome
Fluid resuscitation