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Embolic Mesenteric Infarction

Mesenteric Artery Vascular Embolism


Presentation

  • Our patient had a classical presentation, as he was elderly, had a history of atrial fibrillation with subtherapeutic anticoagulation, and presented with sudden onset abdominal pain with a paucity of clinical signs.[vasculardiseasemanagement.com]
  • See how gastrointestinal conditions present with more than 2,500 multi-modality, high-quality digital images that mirror the findings you're likely to encounter in practice.[books.google.com]
  • Divided into eight sections, the text brings together the emerging leaders in surgery to concisely present and synthesize the key issues in the different surgical disciplines.[books.google.com]
  • Make the most of your limited time with easy-to-digest blocks of information, consistently presented for clear readability and quick reference.[books.google.com]
  • But only a third of patients with AMI present with nausea, vomiting, or diarrhea.[emergencymedicinecases.com]
Hemophilia A
  • Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious[books.google.com]
Fever
  • J Clin Invest 31: 621-2 Resat O, Birgul M, Elif H, Ali M, Fehmi T (2003) Primary antiphospholipid syndrome: a cause of fever of unknown origin. Intern Med. 42: 358-361.[omicsonline.org]
  • Call your provider if you have: Changes in bowel habits Fever Nausea Severe abdominal pain Vomiting The following lifestyle changes can reduce your risk for narrowing of the arteries: Get regular exercise. Follow a healthy diet.[medlineplus.gov]
  • Rectal bleeding and signs of sepsis may develop: shock, rapid heart rate, rapid breathing, metabolic acidosis with dehydration, low blood pressure, fever, and confusion.[diagnose-me.com]
  • Increasing abdominal tenderness with guarding and rebound tenderness, fever, uncontrollable bleeding, and paralytic ileus indicate possible infarction of the colon (severe disease) and require urgent laparotomy and removal of the necrotic part of the[patient.info]
  • They complain of anorexia, loose stools that may be bloody or dark (hemoccult-positive), abdominal distention or fever. Dehydration due to bloody ascites or third space fluid loss causes hypotension.[indjvascsurg.org]
Abdominal Pain
  • Methods: An 83-year-old male with a history of atrial fibrillation presented with acute abdominal pain and was diagnosed to have acute mesenteric ischemia from superior mesenteric artery embolism on computerized tomography angiography.[vasculardiseasemanagement.com]
  • […] first modality, as will illucidate other causes of abdominal pain.[medbullets.com]
  • Non-specific abdominal pain, /-diarrhea and anorexia.[emergencymedicinecases.com]
  • In a series of 58 patients with mesenteric ischemia due to mixed causes: abdominal pain was present in 95% (median of 24 hours duration).[parasitetesting.com]
  • The primary symptom is abdominal pain that has no obvious cause.[diagnose-me.com]
Severe Abdominal Pain
  • Snap Shot A 70-year-old male with atrial fibrillation presents to the emergency department with sudden onset of severe abdominal pain despite relatively benign findings on physical exam.[medbullets.com]
  • Call your provider if you have: Changes in bowel habits Fever Nausea Severe abdominal pain Vomiting The following lifestyle changes can reduce your risk for narrowing of the arteries: Get regular exercise. Follow a healthy diet.[medlineplus.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]
  • Acute Mesenteric Ischemia often presents with sudden and severe abdominal pain.[diagnose-me.com]
  • The symptoms that can occur with mesenteric ischemia include sudden and severe abdominal pain, which is usually associated with acute thrombosis of chronic stenosis/disease, embolization, or dissection, and abdominal pain after eating that leads to weight[commonwealthsurgical.com]
Acute Abdomen
  • Abdomen 413 General Principles of Minimally Invasive Surgery 429 Esophagus 455 Stomach and Duodenum 489 Pancreas 517 Biliary System 553 Liver 585 Small Intestine 617 Appendix 647 Colon Rectum and Anus 667 Spleen 763 Hernias and Abdominal Wall Defects[books.google.com]
  • abdomen, especially where there is no other obvious cause.[teachmesurgery.com]
  • Presentation The condition may be difficult to diagnose, with nonspecific symptoms of an 'acute abdomen', such as acute-onset abdominal pain. The pain is most frequently located in the left iliac fossa.[patient.info]
  • Catheter directed treatment may be the preferred approach, when available, in a patient who presents early without signs of acute abdomen.[vasculardiseasemanagement.com]
Periumbilical Pain
  • Clinical presentation is classically that of acute onset of severe periumbilical pain that is out of proportion to physical exam findings, /- nausea/vomiting. Peritoneal signs and sepsis indicate bowel infarction.[errolozdalga.com]
  • In the evening on the same day, he complained of acute and persistent periumbilical pain without abdominal distension. Bowel sound was decreased, but nausea or vomiting were absent.[e-jnc.org]
  • Pain is the most consistent symptom, which begins with cramping, periumbilical pain due to small bowel ischemia, which evolves into tenderness to palpation with transmural ischemia of the bowel wall.[epmonthly.com]
Decreased Bowel Sounds
  • Abdominal examination revealed periumbilical and epigastric tenderness with decreased bowel sounds. Chest X-ray posteroanterior view showed cardiomegaly with LA enlargement and pulmonary congestion.[annals.in]
Vascular Disease
  • Gain a state-of-the-art understanding of the pathophysiology, diagnosis, and management of arterial disease, venous disease, lymph dysfunction, connective tissue disease, vascular disease, and vascular manifestations of systemic disease.[books.google.com]
  • المحتويات Minimally Invasive Approaches to Vascular Disease 1135 1137 Section Five Cardiothoracic Surgery 1163 Lung Neoplasms 1189 Lung Infections and Trauma 1217 VideoAssisted Thoracic Surgery 1231 Pericardium 1265 Mediastinum 1281 Congenital Heart Disease[books.google.com]
  • Mesenteric ischemia Other names Mesenteric ischaemia, mesenteric vascular disease Computed tomography (CT) showing dilated loops of small bowel with thickened walls (black arrow), findings characteristic of ischemic bowel due to thrombosis of the superior[en.wikipedia.org]
  • Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143. Updated by: Michael M.[medlineplus.gov]
  • This relatively rare but often fatal clinical entity must be considered early in the differential diagnosis of any patient with abdominal symptoms or signs but especially those with a history of intestinal angina, peripheral vascular disease, cardiac[accessmedicine.mhmedical.com]

Workup

Treatment

  • Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual.[books.google.com]
  • Early diagnosis and treatment with prompt laparotomy and embolectomy is the standard treatment. There are reports using percutaneous catheter-based thrombolytic and mechanical clot extraction strategies.[vasculardiseasemanagement.com]
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  • Utilize behavior management as an integral part of treatment for your hypertensive and pre-hypertensive patients. Effectively manage special populations with chronic hypertensive disease, as well as hypertension and concomitant disease.[books.google.com]
  • Even with treatment the risk of death is 30-90%, depending on the stage at which treatment is started.[diagnose-me.com]

Prognosis

  • PROGNOSIS The prognosis depends on prompt diagnosis (less than 12 24 hours and before gangrene) and the underlying cause: venous thrombosis - 32% mortality arterial embolism - 54% mortality arterial thrombosis - 77% mortality non-occlusive ischemia -[parasitetesting.com]
  • Prognosis In cases of mesenteric artery ischemia, prognosis is especially poor if the patient is not treated quickly. Even with treatment the risk of death is 30-90%, depending on the stage at which treatment is started.[diagnose-me.com]
  • Treatment and prognosis An acute SMA occlusion carries a mortality of 75-90% despite treatment 3,5.[radiopaedia.org]
  • Prognosis For most patients the quality of life is poor. The constant fear of abdominal pain that may occur when eating food leads to significant weight loss.[patient.info]
  • The mortality of EAMI remains very high and the most important historical predictors are age and the duration of symptoms before diagnosis. 22-24 Peritoneal signs predict worse prognosis, and renal failure, acidosis from sepsis, and shock are obvious[vasculardiseasemanagement.com]

Etiology

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  • Just six cases of mesenteric ischemia have been diagnosed at Indiana University in young adults over the last 16 years, with Takayasu’s arteritis the most common etiology, he noted.[mdedge.com]
  • The etiology of acute mesenteric ischemia may be embolic, thrombotic, primary vasoconstrictive, or secondary to venous thrombosis.[accessmedicine.mhmedical.com]
  • Acute Mesenteric Ischemia can be further divided into Occlusive vs Non-occlusive etiologies.[errolozdalga.com]
  • […] or diffuse (venous) necrosis of bowel due to decreased blood supply Significant third spacing develops Mucosa dies & sloughs leading to bleeding Bacteria crossing into tissues leading to sepsis, DIC or Systemic Inflammatory Response Syndrome (SIRS) Etiology[fprmed.com]

Epidemiology

  • 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]
Sex distribution
Age distribution

Pathophysiology

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  • Each has helpful exam-ready headings like "Pathophysiology" and "Diagnosis". These articles were remixed into the summary which follows.[derangedphysiology.com]
  • This review article explains the pathophysiology, diagnosis, and treatment of intestinal ischemic syndromes. Funding and Disclosures Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Dr.[nejm.org]
  • I just read that wikipedia page... please refer on that same page to "non-occlusive ischemia" and "pathophysiology".[forums.studentdoctor.net]
  • This discussion will focus on the etiology, pathophysiology, diagnosis, and management of acute mesenteric ischemia. Table 86–1. Potential Causes of Acute Mesenteric Ischaemia[accessmedicine.mhmedical.com]

Prevention

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  • How to use an article about therapy or prevention: A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 1993:270:2598-2601. 33. Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. ‏[books.google.com]
  • CHICAGO – Early recognition of mesenteric ischemia in young adults and children is essential to prevent bowel loss and other serious consequences associated with this rare condition, Dr. Michael Dalsing said at a vascular surgery symposium.[mdedge.com]
  • The stent can prevent the artery from closing again. Your doctor may also want to perform a coronary artery bypass graft (CABG) in some cases.[healthline.com]
  • After successful treatment it is important to make lifestyle changes (such as a healthy diet and exercise) to prevent hardening of the arteries from getting worse.[diagnose-me.com]

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