Presentation
Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. [ncbi.nlm.nih.gov]
Entire Body System
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Weight Loss
loss AND YOU may hear the story of FOOD FEAR ( Pat comes with chronic abdominal pain right after meal/ u recall angina pain that like pain with exertion) Dx; CBC/leukocytosis, Lactic/or metabolic ACIDOSIS, Amylase UP. [usmleforum.com]
A second patient with Takayasu’s presented with a 4-month history of abdominal pain, a 50-pound weight loss, stenosis of all major mesenteric arteries, and bowel pneumatosis. [mdedge.com]
These blood clots in the small intestine and bowels can lead to: Weight loss Pain with eating Fear of food Left untreated over time, blockages can decrease blood flow so much that the tissues in your intestines die. [upmc.com]
WEIGHT LOSS CHRONIC mesenteric ischemia sometimes leads you to lose weight because, although you may feel hungry, you eat less or less frequently to avoid the pain. [vascular.org]
Respiratoric
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Hypoventilation
All patients presented hypoventilation, arterial hypotension, oliguria and,from a biological standpoint, metabolic acidosis and leucocytosis. Superior mesenteric artery angiography was the investigation method of choice. [ncbi.nlm.nih.gov]
Gastrointestinal
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Abdominal Pain
A 79-yr-old man with previously documented atherosclerotic vascular disease presented with acute abdominal pain, signs of peritoneal irritation, and guaiac-positive stool. [ncbi.nlm.nih.gov]
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Vomiting
We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. [ncbi.nlm.nih.gov]
Arterial emboli typically originate from a cardiac source. 1,2 Case Report A male in his fifth decade presented with acute abdominal pain, vomiting, and diarrhea. [acgcasereports.gi.org]
Pancreatitis Portal hypertension/cirrhosis Medications Vasopressor medications Beta-blockers Digoxin Diuretics Clinical signs and symptoms Severe abdominal pain out of proportion to physical exam Pain initially of a visceral nature and poorly localized Nausea Vomiting [learningradiology.com]
SMA/Celiac axis/IMA Acute: -Thrombosis/Emboli/ HypOtension/ Shock / time vasoconstriction ( vasospasm) venous block from thrombosis -On exam, pat pain out proportion ( hematochezia &/OR melena ) Chronic: History of atherosclerotic - As usual Nausea/vomiting [usmleforum.com]
Anorexia, nausea, vomiting, diarrhea, and hematochezia are common. Unfortunately, the clinical manifestations of AMI overlap with other, more common clinical entities, such as bowel obstruction, pancreatitis, diverticulitis, and peritonitis. [radiologykey.com]
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Diarrhea
We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. [ncbi.nlm.nih.gov]
ISCHEMIC COLITIS You see pat L side abdominal pain with BLOODY DIARRHEA/[Note: in mild cases pat usually have blooding diarrhea but no abdominal pain] (due to mucosal or mural infarction) as u know MC site splenic flexure and rectum most commonly spared [usmleforum.com]
Arterial emboli typically originate from a cardiac source. 1,2 Case Report A male in his fifth decade presented with acute abdominal pain, vomiting, and diarrhea. [acgcasereports.gi.org]
[…] hypertension/cirrhosis Medications Vasopressor medications Beta-blockers Digoxin Diuretics Clinical signs and symptoms Severe abdominal pain out of proportion to physical exam Pain initially of a visceral nature and poorly localized Nausea Vomiting Diarrhea [learningradiology.com]
Anorexia, nausea, vomiting, diarrhea, and hematochezia are common. Unfortunately, the clinical manifestations of AMI overlap with other, more common clinical entities, such as bowel obstruction, pancreatitis, diverticulitis, and peritonitis. [radiologykey.com]
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Nausea
We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. [ncbi.nlm.nih.gov]
Pancreatitis Portal hypertension/cirrhosis Medications Vasopressor medications Beta-blockers Digoxin Diuretics Clinical signs and symptoms Severe abdominal pain out of proportion to physical exam Pain initially of a visceral nature and poorly localized Nausea [learningradiology.com]
[…] injury -SMA/Celiac axis/IMA Acute: -Thrombosis/Emboli/ HypOtension/ Shock / time vasoconstriction ( vasospasm) venous block from thrombosis -On exam, pat pain out proportion ( hematochezia &/OR melena ) Chronic: History of atherosclerotic - As usual Nausea [usmleforum.com]
Anorexia, nausea, vomiting, diarrhea, and hematochezia are common. Unfortunately, the clinical manifestations of AMI overlap with other, more common clinical entities, such as bowel obstruction, pancreatitis, diverticulitis, and peritonitis. [radiologykey.com]
You have given both patients IV pain and nausea medication, but their pain has continued. You order a CT angiography for both. [epmonthly.com]
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Severe Abdominal Pain
The diagnosis of mesenteric ischemia should be considered in patients of any age presenting with recurrent or severe abdominal pain, particularly when no alternative cause is apparent. [ncbi.nlm.nih.gov]
abdominal pain out of proportion to physical exam Pain initially of a visceral nature and poorly localized Nausea Vomiting Diarrhea GI bleeding may be present Imaging Plain abdominal radiographs (abnormal in 20-60% of cases) Thumbprinting Non-specific [learningradiology.com]
Mesenteric ischemia must be considered in any patient 50 with known risk factors or predisposing conditions who develops sudden, severe abdominal pain. [merckmanuals.com]
Cardiovascular
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Mitral Valve Prolapse
Echocardiography showed enlargement of the aortic root and mitral valve prolapse. Abdominal computed tomography scan revealed acute mesenteric ischemia due to abdominal aortic dissection. [ncbi.nlm.nih.gov]
Workup
On further workup, our patient was diagnosed with isolated protein S deficiency. We started lifelong thromboprophylaxis with warfarin to prevent recurrence and our patient was asymptomatic on the latest follow-up 5 months after discharge. [ncbi.nlm.nih.gov]
Although we pointed out the limitations of CT-scan, we keep thinking that it should remain the cornerstone of the diagnostic workup of AMI in the ICU. [annalsofintensivecare.springeropen.com]
Treatment
The treatment strategy is straightforward aiming at rapid restoration of blood flow to the intestine. Bowel resection is performed on demand. [ncbi.nlm.nih.gov]
Prognosis
The prognosis of AMI is extremely poor. The main mechanism of AMI is NOMI, occurring in approximately 80% of patients. Further progress should be performed on prevention and earlier diagnosis. [ncbi.nlm.nih.gov]
Etiology
Acuity of presentation, presence of bowel infarction, etiology of the ischemia, and risk factors may influence a planned treatment approach. [ncbi.nlm.nih.gov]
Risk factors for AMI vary depending on the underlying etiology. [radiologykey.com]
Epidemiology
Epidemiological data, CT findings, and the primary end point defined as the composite of intestinal ischemia or necrosis based on surgical finding and in-hospital mortality were investigated. [ncbi.nlm.nih.gov]
Epidemiology The incidence of ischaemic colitis has risen from 6.1 cases/100 000 person-years in 1976-80 to 22.9/100 000 in 2005-09 [ 5 ]. Many mild cases may go unreported. [patient.info]
Biochemistry (187) Genetics (137) Infectology (107) Nephrology (97) Microbiology (89) Surgery, Traumatology and Orthopaedics (82) Gastroenterology and Hepatology (70) Neurology (70) Cardiology, Angiology (66) Pharmacology (63) Endocrinology, Metabolism (55) Epidemiology [portal.mefanet.cz]
[…] flow to the small intestine (arterial or venous) that can result in bowel infarction Chronic mesenteric ischemia : constant or episodic hypoperfusion of the small intestine, usually due to atherosclerosis References: [1] [2] [3] [4] Ischemic colitis Epidemiology [amboss.com]
The following variables were recorded: epidemiological data (age and sex), risk factors (atrial fibrillation, prothrombotic states and low output pathologies, etc.), such as AMI (arterial embolism, arterial thrombosis, venous thrombosis or non-occlusive [elsevier.es]
Pathophysiology
This is the first report of massive bowel ischaemia and duodenal perforation with no apparent underlying common pathophysiology leading to this presentation. [ncbi.nlm.nih.gov]
Pathophysiology The main mechanism underlying mesenteric ischemia is decreased blood flow to the small intestine. [wikidoc.org]
Pathophysiology The intestinal mucosa has a high metabolic rate and, accordingly, a high blood flow requirement (normally receiving 20 to 25% of cardiac output), making it very sensitive to the effects of decreased perfusion. [merckmanuals.com]
Pathophysiology Intestinal blood flow of the superior mesenteric artery ( SMA ) and/or inferior mesenteric artery ( IMA ) is suddenly compromised (see “Etiology” for causes) intestinal hypoxia intestinal wall damage mucosal inflammation possibly bleeding [amboss.com]
Pathophysiology and epidemiology Acute mesenteric arterial embolism Roughly, 50% of all cases of AMI are due to acute mesenteric embolism [ 2, 3 ]. [wjes.biomedcentral.com]
Prevention
Early diagnosis and immediate anticoagulation will prevent subsequent complications and need for surgical intervention. [ncbi.nlm.nih.gov]