Intestinal Ischaemia

• What is acute mesenteric ischemia (AMI)?

  AMI is a serious condition characterized by sudden onset intestinal hypoperfusion.
• What are the typical symptoms of acute mesenteric ischemia?


  Symptoms include severe abdominal pain, nausea, vomiting, and signs of shock.
• Which artery is primarily involved in acute mesenteric ischemia?


  The superior mesenteric artery.
• How is acute mesenteric ischemia diagnosed?


  Diagnostic confirmation is generally made through CT angiography.
• What are key risk factors for acute mesenteric ischemia?


  Key risk factors include atrial fibrillation, atherosclerosis, and coagulopathy.
• What is the primary management approach for acute mesenteric ischemia?


  Management involves rapid diagnosis, stabilization of the patient, and interventions to restore perfusion.
• What is the definition of acute mesenteric ischemia?


  AMI is a life-threatening surgical emergency characterized by blood flow restriction to the small intestine.
• What are the two types of blood flow disruption in acute mesenteric ischemia?


  The disruption may be either occlusive or non-occlusive.
• What percentage of hospital admissions does acute mesenteric ischemia represent?


  Approximately 0.1% of all hospital admissions.
• What is the mortality rate associated with acute mesenteric ischemia?


  The mortality rate ranges from 60-80%.
• In which age group does acute mesenteric ischemia most commonly occur?


  In individuals over 60 years old.
• What are the main causes of acute mesenteric ischemia?


  • Arterial Embolism: Often from atrial fibrillation or embolic sources.
  • Arterial Thrombosis: Associated with atherosclerosis.
  • Venous Thrombosis: Linked to hypercoagulable states.
  • Non-Occlusive Mesenteric Ischemia: Associated with low-flow states.
• What are the common signs and symptoms of acute mesenteric ischemia?


  • Sudden severe abdominal pain and guarding
  • Nausea and vomiting
  • Signs of shock (hypotension, tachycardia, altered mental status)
  • Metabolic acidosis on arterial blood gas analysis
  • Possible rectal bleeding in advanced ischemia
• What differential diagnoses should be considered for acute mesenteric ischemia?


  • Peptic Ulcer Disease
  • Acute Pancreatitis
  • Acute Cholecystitis
  • Acute Appendicitis
  • Diverticulitis
• What initial investigations should be conducted for acute mesenteric ischemia?


  • Blood tests: Full blood count, liver function tests, renal function, coagulation profile, lactate levels
  • Arterial blood gas analysis for metabolic acidosis
  • Imaging: CT angiography
• What are the primary objectives in managing acute mesenteric ischemia?


  • Rapid diagnosis
  • Stabilization of the patient
  • Restoration of bowel perfusion
• What are the management strategies for acute mesenteric ischemia?


  • Resuscitation: Fluid management and correction of metabolic abnormalities
  • Anticoagulation: Typically with intravenous heparin
  • Surgical intervention: Embolectomy, arterial bypass, or bowel resection
  • Non-surgical intervention: Intra-arterial vasodilators or thrombolytic therapy
  • Supportive care: Analgesia, antibiotics, and nutritional support