Intestinal ischaemia

• What is acute mesenteric ischaemia?

  Rapid onset of hypoperfusion to a portion of the small intestine - may be either occlusive or non-occlusive
• What arteries does acute mesenteric ischaemia normally affect?

  SMA
• What is chronic mesenteric ischaemia?

  Gradual blockage or narrowing of mesenteric arteries = insufficient blood supply to the intestines
• What causes occlusive ischaemia?

  Physical obstruction
• What causes non-occlusive ischaemia?

  Hypoperfusion or vasospasm
• What is the onset of symptoms for occlusive ischaemia?

  Sudden and severe
• What is the onset of symptoms for non-occlusive ischaemia?

  Gradual
• What are some risk factors for occlusive ischaemia?

  Embolism

  Atherosclerosis
• What are some risk factors for non-occlusive ischaemia?

  Shock

  Heart failure

  Vasopressors
• How is occlusive ischaemia diagnosed and what is shown?

  How: CT angio

  Shown: Obstruction
• How is non-occlusive ischaemia diagnosed and what is shown?

  How: CT angio

  Shown: Narrowed vessels
• How is occlusive ischaemia managed?

  Surgery

  Anticoags
• How is non-occlusive ischaemia managed?

  Restore perfusion

  Manage underlying cause
• What are the most common causes for acute intestinal ischaemia?

  Arterial embolism

  Artherial thrombosis

  Venous thrombosis
• What are some risk factors for developing chronic intestinal ischaemia?

  Smoking

  Diabetes

  Arterial disease

  Afib
• What are some signs and symptoms of acute intestinal ischaemia?

  Sudden severe abdo pain

  Guarding

  Nausea

  Vomitng

  Signs of shock
• What may be shown on an ABG for acute intestinal ischaemia?

  Metabolic acidosis
• What are some signs and symptoms for chronic intestinal ischaemia?

  Diffuse colicky abdo pain

  Abdo tenderness

  Weight loss

  Diarrhoea

  Epigastric bruit
• What is the gold standard investigation for acute intestinal ischaemia?

  CT angio
• What is the gold standard investigation for chronic intestinal ischaemia?

  CT angio
• What may blood tests are done for acute intestinal ischaemia?

  FBC

  LFTs

  Coag

  Lactate
• What are some bedside investigations for chronic intestinal ischaemia?

  VBG - raised lactate
• Why may lactate levels be raised in intestinal ischaemia?

  Hypoxia -> inc anaerobic respiration
• Why may WBC and CRP be raised in intestinal ischaemia?

  Inflammation
• How is acute intestinal ischaemia managed?

  Analgesia

  Fluid management

  Anticoag

  Surgery
• How is chronic intestinal ischaemia managed?

  Lifestyle changes

  Symptom management

  Revascularisation