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23 Cards in this Set
- Front
- Back
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Where is Watershed region? Why important?
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L colic area, single blood supply from L colic
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What does small bowel ischemia often indicate?
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multiple blockages of blood supply
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Where is the first areas affected with ischemia of enterocytes?
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villus tip enterocytes
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2 injuries with gut ischemia
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hypoxia AND reperfusion (superoxide damage)
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Clinical presentation of ischemia
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pain when otherwise normal Physical exam
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signs of mucosal and submucosal hemorrhage
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ulcerations, blood in stool, thumbprinting
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Most common incidence of intestinal ischemia?
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colonic ischemia
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Presentation of ischemic colitis
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crampy LLQ abd pain
hematochezia/bloody diarrhea ab tenderness rebound tenderness could signify peritonitis |
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Risk factors for ischemic colitis
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older age
cardiac (CHF, arrhythmias, cardiac sx) hypotensive states (hypovolemia, sepsis, dialysis) hypercoaguable state |
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Ischemic colitis on X-ray
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thumbprinting
segmental distribution (rectal sparing) later: loss of haustrations, stricture |
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Ischemic colitis on endoscopy
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mucosal edema and erythema
hemorrhagic nodules ulceration gangrene stricture |
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Tx for ischemic colitis
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supportive care (underlying cause)
reversal of underlying factors |
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Complications of ischemic colitis
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fulminant colitis
necrosis perforation bacteremia chronic segmental colitis stricture |
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2 most common causes of acute mesenteric ischemia
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SMA embolus
nonocclusive mesenteric ischemia |
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Presentation of acute mesenteric ischemia
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acute ab pain (out of proportion to PE)
unexplained abd distension, GI bleeding Bacteremia/sepsis after CPR SMA embolus (acute severe pain after forceful BM) |
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Dx of acute mesenteric ischemia
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angiography
lactic acid and thumbprinting are late signs Tx w/ vasodilator therapy during procedure |
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Most common acute SMA thrombosis site
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SMA origin
often superimposed on chronic mesenteric ischemia |
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Non-occlusive mesenteric ischemia precipitating event
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splanchnic vasoconstriction secondary to CV event
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Similar dz to mesenteric venous thrombosis
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Budd-Chiari syndrome
Can be acute, subacute, or chronic |
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Presentation of Chronic mesenteric ischemia
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abdominal crampy pain that occurs w/in 30 min of eating
gradually inc, resolves over 1-3 hrs progresses over wks/mo |
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Pathophys of Chronic mesenteric ischemia
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results from "stealing" of blood from small bowel, diverted to stomach
sitophobia |
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Tx of chronic mesenteric ischemia
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revascularization
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Which dz should receive antibiotics?
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acute small bowel ischemia
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