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Mesenteric Ischemia

 Syn. Mesenteric vascular insufficiency , Ischemia, Mesenteric , Mesenteric angina

Signs & Symptoms

 Over age 60 years #colonic #Ischemic_Colitis
Ref: Uptodate [ Acute mesenteric ischemia (Table 1)]
Severe periumbilical pain #small_bowel_involvement #Criteria
Note: patient with acute abdominal pain and metabolic acidosis has intestinal ischemia until proven otherwise
Ref: Uptodate [ Acute mesenteric ischemia]
Has precipitating cause #small_bowel_involvement
Ref: Uptodate [ Acute mesenteric ischemia (Table 1)]
Nonspecific abdominal pain #subacute
Ref: Uptodate [ Acute mesenteric ischemia]

Physical Examination

 Severe periumbilical pain #small_bowel_involvement #Criteria
Note: patient with acute abdominal pain and metabolic acidosis has intestinal ischemia until proven otherwise
Ref: Uptodate [ Acute mesenteric ischemia]
Sudden onset pain #embolic #Mesenteric_Infarction #arterioocclusive #thrombotic #colonic #Ischemic_Colitis
Ref: Uptodate [ Acute mesenteric ischemia] Harrison [ 2293]
Appear severely ill #small_bowel_involvement #Acute
Ref: Uptodate [ Acute mesenteric ischemia (Table 1)] Harrison [ 2292]

Lab / Serology

 Elevated phosphate
Ref: Uptodate [ Acute mesenteric ischemia]
Metabolic acidosis #Criteria
Note: patient with acute abdominal pain and metabolic acidosis has intestinal ischemia until proven otherwise
Ref: Uptodate [ Acute mesenteric ischemia] Harrison [ 2293]
Occult blood in stool
Ref: Uptodate [ Acute mesenteric ischemia]

Imagin Study

 CT angiography show bowel-wall thickening #thrombotic
Ref: Harrison [ 2293]
CT angiography show ascites #thrombotic
Ref: Harrison [ 2293]
CT angiography show delayed arterial phase #thrombotic
Note: IV contrast
Ref: Harrison [ 2293]

Complication

 Splenic vein thrombosis
Note: cause bleeding from esophageal, cause bleeding from gastric varices
Ref: Uptodate [ Acute mesenteric ischemia]

Risk Factors

 Age > 60
Ref: Unknown [ 0]
Irritable bowel syndrome
Ref: Epocrates [ https://online.epocrates.com/diseases/81823/Ischemic-bowel-disease/Epidemiology]
Vasculitis
Ref: Epocrates [ https://online.epocrates.com/diseases/81832/Ischemic-bowel-disease/Risk-Factors]

Cause

 Mesenteric arterial embolism
Ref: Uptodate [ Overview of intestinal ischemia in adults]
Intestinal hypoperfusion
Note: nonocclusive mesenteric ischemia
Ref: Uptodate [ Overview of intestinal ischemia in adults]
Mesenteric venous thrombosis
Ref: Uptodate [ Overview of intestinal ischemia in adults]

Other