Mesenteric ischemia history and symptoms: Difference between revisions

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Latest revision as of 20:01, 19 January 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

The hallmark of mesenteric ischemia symptoms is 'abdominal pain out of proportion to the examination findings'. A positive history of chronic cardiovascular disorder, old age and abdominal pain is suggestive of mesenteric ischemia, unless proven otherwise. The most common symptoms of mesenteric ischemia include excruciating abdominal pain, bloody diarrhea, and nausea/vomiting. Symptoms of chronic mesenteric ischemia caused by atherosclerosis include abdominal pain after eating and diarrhea, while that of acute mesenteric ischemia due to an embolus include diarrhea, sudden severe abdominal pain, and vomiting.

History

Patients suffering from mesenteric ischemia may have a positive history of:^[1]^[2]

Personal history	Medical history	Surgical history	Family history
History of smoking High cholesterol level Sedentery life style Hyperlipidemia	Coronary heart disease Cerebrovascular disease Vasculitis Peripheral artery disease Irregular cardiac rythm disorders Such as atrial fibrillation Malignancy Chronic liver disease Portal vein thrombosis Inflammatory disease Thrombophilia Inflammatory bowel disease	Recent abdominal surgery	Family history of Deep venous thrombosis Pulmonary embolism Myeloproliferative disorders

Symptoms

The severity and rapidity of mesenteric vessels occlusion determine the symptoms of mesenteric ischemia. ^[3]^[4]^[5]
Systemic classification of acute and chronic mesenteric ischemia symptoms is as follows:

Acute mesenteric ischemia			Chronic mesenteric ischemia
General symptoms	Gastrointestinal symptoms	Life threatening symptoms	General symptoms	Gastrointestinal symptoms
Malaise Nausea (44%) Fever Mental confusion Heart rate > 100 in 33%	Abdominal Pain:(present in 95% cases) Site: Periumbilical. Focal pain in case of bowel necrosis. Onset: Sudden Character: Sharp or colicky Severity: Moderate to severe Timing, duration and frequency: Arterial occlusion: 2-3 hours Venous occlusion: 5 hours to more than 30 days Aggravating and relieving factors: No association with meals Other associations: Urgency to bowel movements Vomiting (35%) Diarrhea (35%) Constipation Blood per rectum Abdominal distention Increased frequency of bowel movements	Signs of shock: Palpitations Low blood pressure Altered mental status Shortness of breath	Nausea Bloating	Abdominal pain: Site: Poorly localised Onset: Insidious Character: Transient episodes of pain. Severity: Mild Timing, duration and frequency: Months Aggravating and relieving factors: Worse after meals. Other associations: Fullness after eating Worsening abdominal pain Aversion to eating Unintentional weight loss Diarrhea

References

↑ Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ (2012). "The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds". Am J Med. 125 (4): 394–8. doi:10.1016/j.amjmed.2011.09.013. PMID 22305578.
↑ Sreenarasimhaiah J (2005). "Chronic mesenteric ischemia". Best Pract Res Clin Gastroenterol. 19 (2): 283–95. doi:10.1016/j.bpg.2004.11.002. PMID 15833694.
↑ Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004). "Acute mesenteric ischemia: a clinical review". Arch. Intern. Med. 164 (10): 1054–62. doi:10.1001/archinte.164.10.1054. PMID 15159262.
↑ Font VE, Hermann RE, Longworth DL (1989). "Chronic mesenteric venous thrombosis: difficult diagnosis and therapy". Cleveland Clinic journal of medicine. 56 (8): 823–8. PMID 2691119.
↑ Bobadilla, Joseph L. (2013). "Mesenteric Ischemia". Surgical Clinics of North America. 93 (4): 925–940. doi:10.1016/j.suc.2013.04.002. ISSN 0039-6109.

[pmid22305578-1] Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ (2012). "The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds". Am J Med. 125 (4): 394–8. doi:10.1016/j.amjmed.2011.09.013. PMID 22305578.

[pmid15833694-2] Sreenarasimhaiah J (2005). "Chronic mesenteric ischemia". Best Pract Res Clin Gastroenterol. 19 (2): 283–95. doi:10.1016/j.bpg.2004.11.002. PMID 15833694.

[pmid15159262-3] Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004). "Acute mesenteric ischemia: a clinical review". Arch. Intern. Med. 164 (10): 1054–62. doi:10.1001/archinte.164.10.1054. PMID 15159262.

[pmid2691119-4] Font VE, Hermann RE, Longworth DL (1989). "Chronic mesenteric venous thrombosis: difficult diagnosis and therapy". Cleveland Clinic journal of medicine. 56 (8): 823–8. PMID 2691119.

[Bobadilla2013-5] Bobadilla, Joseph L. (2013). "Mesenteric Ischemia". Surgical Clinics of North America. 93 (4): 925–940. doi:10.1016/j.suc.2013.04.002. ISSN 0039-6109.

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[2]

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[4]

[5]

@@ Line 4: / Line 4: @@
 ==Overview==
-Symptoms of chronic mesenteric ischemia caused by [[atherosclerosis]] include abdominal pain after eating and diarrhea.  Symptoms of acute mesenteric artery ischemia due to an embolus include diarrhea, sudden severe abdominal pain, and vomiting.
+The hallmark of [[mesenteric ischemia]] symptoms  is '[[abdominal pain]] out of proportion to the examination findings'. A positive history of chronic [[cardiovascular]] disorder, old age and [[abdominal pain]] is suggestive of mesenteric ischemia, unless proven otherwise. The most common symptoms of [[mesenteric ischemia]] include excruciating [[Abdomen|abdominal]] pain, [[Dysentery|bloody diarrhea]], and [[Nausea and vomiting|nausea]]/[[Nausea and vomiting|vomiting]]. Symptoms of [[chronic]] [[Mesenteric ischemia|mesenteric]] [[ischemia]] caused by [[atherosclerosis]] include [[Abdomen|abdominal]] pain after eating and [[diarrhea]], while that of [[acute]] [[Mesenteric ischemia|mesenteric]] [[ischemia]] due to an [[Embolism|embolus]] include [[diarrhea]], sudden severe [[Abdominal pain|abdominal]] pain, and [[Nausea and vomiting|vomiting]].
 ==History==
+Patients suffering from mesenteric ischemia may have a positive history of:<ref name="pmid22305578">{{cite journal| author=Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ| title=The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds. | journal=Am J Med | year= 2012 | volume= 125 | issue= 4 | pages= 394-8 | pmid=22305578 | doi=10.1016/j.amjmed.2011.09.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305578  }} </ref><ref name="pmid15833694">{{cite journal| author=Sreenarasimhaiah J| title=Chronic mesenteric ischemia. | journal=Best Pract Res Clin Gastroenterol | year= 2005 | volume= 19 | issue= 2 | pages= 283-95 | pmid=15833694 | doi=10.1016/j.bpg.2004.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15833694  }} </ref>
+{| class="wikitable"
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Personal history
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Medical history
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Surgical history
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Family history
+|-
+|
+* History of smoking
+* High [[cholesterol]] level
+* Sedentery life style
+* [[Hyperlipidemia (patient information)|Hyperlipidemia]]
+|
+* [[Coronary heart disease]]
+* [[Cerebrovascular disease]]
+* [[Vasculitis]]
+* [[Peripheral arterial disease|Peripheral artery disease]]
+* [[Irregular heart rhythms|Irregular]] [[Heart|cardiac]] rythm disorders
+Such as [[atrial fibrillation]]
+* [[Cancer|Malignancy]]
+* [[Chronic liver disease]]
+* [[Portal vein thrombosis]]
+* [[Inflammation|Inflammatory disease]]
+* [[Thrombophilia]]
+* [[Inflammatory bowel disease]]
+|
+* Recent [[Abdomen|abdominal]] [[surgery]]
+|Family history of
+* [[Deep vein thrombosis|Deep venous thrombosis]]
+* [[Pulmonary embolism]]
+* [[Myeloproliferative neoplasm|Myeloproliferative disorders]]
+|}
 ==Symptoms==
-Symptoms of mesenteric ischemia depend on the severity of occlusion and can be acute (especially if embolic)<ref name="pmid15159262">{{cite journal |author=Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD |title=Acute mesenteric ischemia: a clinical review |journal=Arch. Intern. Med. |volume=164 |issue=10 |pages=1054-62 |year=2004 |pmid=15159262 | doi=10.1001/archinte.164.10.1054}}</ref>, subacute, or chronic<ref name="pmid2691119">{{cite journal |author=Font VE, Hermann RE, Longworth DL |title=Chronic mesenteric venous thrombosis: difficult diagnosis and therapy |journal=Cleveland Clinic journal of medicine |volume=56 |issue=8 |pages=823-8 |year=1989 |pmid=2691119}}</ref>.
+* The severity and rapidity of [[Mesentery|mesenteric]] [[Blood vessel|vessels]] [[occlusion]] determine the symptoms of [[mesenteric ischemia]]. <ref name="pmid15159262">{{cite journal |author=Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD |title=Acute mesenteric ischemia: a clinical review |journal=Arch. Intern. Med. |volume=164 |issue=10 |pages=1054-62 |year=2004 |pmid=15159262 | doi=10.1001/archinte.164.10.1054}}</ref><ref name="pmid2691119">{{cite journal |author=Font VE, Hermann RE, Longworth DL |title=Chronic mesenteric venous thrombosis: difficult diagnosis and therapy |journal=Cleveland Clinic journal of medicine |volume=56 |issue=8 |pages=823-8 |year=1989 |pmid=2691119}}</ref><ref name="Bobadilla2013">{{cite journal|last1=Bobadilla|first1=Joseph L.|title=Mesenteric Ischemia|journal=Surgical Clinics of North America|volume=93|issue=4|year=2013|pages=925–940|issn=00396109|doi=10.1016/j.suc.2013.04.002}}</ref>
+* Systemic classification of acute and chronic [[mesenteric ischemia]] symptoms is as follows:
-Systemic classification of symptoms is as follows:
 {| class="wikitable"
-! colspan="3" |Acute mesentric ischemia
+! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Acute mesenteric ischemia
-! colspan="2" |Chronic mesenteric ischemia
+! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Chronic mesenteric ischemia
 |-
-!General symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" |General symptoms
-!Gastrointestinal symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" |[[Gastrointestinal tract|Gastrointestinal]] symptoms
-!Life threatening symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Life threatening symptoms
-!General symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" |General symptoms
-!Gastrointestinal symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" |[[Gastrointestinal tract|Gastrointestinal]] symptoms
 |-
 |
-* Malaise
+* [[Malaise]]
-* Nausea
+* [[Nausea and vomiting|Nausea]] (44%)
-* Fever
+* [[Fever]]
 * Mental confusion
+* [[Heart rate]] > 100 in 33%
 |
-* '''Abdominal Pain:'''(present in 95% cases)
+* '''[[Abdominal pain|Abdominal]] Pain:'''(present in 95% cases)
-Site:
+* Site: Periumbilical. Focal pain in case of bowel necrosis.
-Onset: Sudden
+* Onset: Sudden
-Character:
+* Character: Sharp or colicky
-Severity: Moderate to severe
+* Severity: Moderate to severe
+* Timing, duration and frequency:
+**Arterial occlusion: 2-3 hours
+**Venous occlusion: 5 hours to more than 30 days
+* Aggravating and relieving factors: No association with meals
+'''Other associations:'''
 * Urgency to bowel movements
-* Vomiting (35%)
+* [[Nausea and vomiting|Vomiting]] (35%)
-* Diarrhea (35%)
+* [[Diarrhea]] (35%)
-* Constipation
+* [[Constipation]]
 * Blood per rectum
-* Abdominal distention
+* [[Abdominal distension|Abdominal distention]]
-* Frequency in bowel movements
+* Increased frequency of bowel movements
+|'''Signs of [[shock]]:'''
+* [[Palpitation|Palpitations]]
+* Low [[blood pressure]]
+* [[Altered mental status]]
+* [[Dyspnea|Shortness of breath]]
 |
+* [[Nausea and vomiting|Nausea]]
+* [[Bloating]]
 |
-* Nausea
+* '''[[Abdominal pain|Abdominal]] pain:'''
-* Bloating
-|
+* Site: Poorly localised
+* Onset: Insidious
+* Character: Transient episodes of pain.
+* Severity: Mild
+* Timing, duration and frequency: Months
+* Aggravating and relieving factors: Worse after meals.
+'''Other associations:'''
 * Fullness after eating
-* Worsening abdominal pain
+* Worsening [[Abdomen|abdominal]] pain
 * Aversion to eating
-* Unintentional weight loss
+* Unintentional [[Weight loss|weight]] loss
+* [[Diarrhea]]
 |}
-* [[Abdominal pain]] was present in 95% (median of 24 hours duration). The other three patients presented with shock and [[metabolic acidosis]].
-* [[Nausea]] in 44%
-* [[Vomiting]] in 35%
-* [[Diarrhea]] in 35%
-* [[Heart rate]] > 100 in 33%
-* 'Blood per rectum' in 16% (not stated if this number also included [[occult blood]] - presumably not)
-* [[Constipation]] 7%
 ==References==