Mesenteric ischemia causes: Difference between revisions
/* 2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)-Recommendations: Etiology of Acute Nonocclusive Intestinal Ischemia (DO NOT EDIT){{cite journ... |
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==Causes== | ==Causes== | ||
* [[ | Narrowing of the arteries that supply blood to the intestine causes mesenteric ischemia. The arteries that supply blood to the intestines run directly from the aorta. Mesenteric ischemia is often seen in people who have hardening of the arteries in other parts of the body (for example, those with coronary artery disease or peripheral vascular disease). The condition is more common in smokers and in patients with high blood pressure or blood cholesterol. Mesenteric ischemia may also be caused by an embolus that suddenly blocks one of the mesenteric arteries. The emboli usually come from the heart or aorta. These clots are more commonly seen in patients with arrhythmias, such as atrial fibrillation. They can be broadly classified into four categories:<ref name="pmid2194948">{{cite journal| author=Reinus JF, Brandt LJ, Boley SJ| title=Ischemic diseases of the bowel. | journal=Gastroenterol Clin North Am | year= 1990 | volume= 19 | issue= 2 | pages= 319-43 | pmid=2194948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2194948 }} </ref> | ||
* [[Arterial embolism]] | *[[Arterial thrombosis]] | ||
* [[ | *[[Arterial embolism]] | ||
* [[Non-occlusive ischemia]] | *[[Venous thrombosis]] | ||
*[[Non-occlusive ischemia]] | |||
{| class="wikitable" | |||
! colspan="4" |Classification based on etiology | |||
|- | |||
!Etiology | |||
!Cause | |||
!Incidence | |||
!Examples | |||
|- | |||
! rowspan="3" |Occlusive causes | |||
|Aterial embolism | |||
|50-70% | |||
| | |||
* Superior mesenteric artery obstruction (most common cause) | |||
* [[Arrhythmia]] | |||
* [[Myocardial infarction]] | |||
* [[Infective endocarditis]] | |||
* [[Valvular heart disease|Valvular heart diseases]] | |||
* [[Ventricular aneurysm|Ventricular aneurysms]] | |||
* History of embolic events | |||
* Recent [[angiography]] | |||
|- | |||
|Arterial thrombosis | |||
|15-25% | |||
| | |||
* Atherosclerosis | |||
* Advanced age | |||
* Prolonged hypotension | |||
* [[Hypercoagulability|Hypercoagulabilty]] states | |||
* [[Peripheral arterial disease]] | |||
* Traumatic injury | |||
|- | |||
|Venous thrombosis | |||
|5% | |||
| | |||
* Right-sided heart failure | |||
* Previous deep venous thrombosis (20-40% risk) | |||
* Primary clotting disorder | |||
* Pancreatitis | |||
* Polycythemia | |||
* Sickle cell anemia | |||
* Recent abdominal surgery or infection | |||
|- | |||
|Non-Occlusive causes | |||
|Non-occlusive ischemia | |||
|20-30% | |||
| | |||
* Low cardiac output states(most commom cause) | |||
* Hypovolemia | |||
* Vasoconstrictive drugs (Digoxin, alpha-adrernergic agonists) | |||
* Septic schock | |||
* Aortic insufficiency | |||
* Cocaine abuse or ergot poisoning | |||
|} | |||
==Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines<ref name="pmid23473760">{{cite journal| author=Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 14 | pages= 1555-70 | pmid=23473760 | doi=10.1016/j.jacc.2013.01.004 | pmc=4492473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473760 }} </ref>== | ==Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines<ref name="pmid23473760">{{cite journal| author=Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 14 | pages= 1555-70 | pmid=23473760 | doi=10.1016/j.jacc.2013.01.004 | pmc=4492473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473760 }} </ref>== | ||
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Overview
Narrowing of the arteries that supply blood to the intestine causes mesenteric ischemia. The arteries that supply blood to the intestines run directly from the aorta. Mesenteric ischemia is often seen in people who have hardening of the arteries in other parts of the body (for example, those with coronary artery disease or peripheral vascular disease). The condition is more common in smokers and in patients with high blood pressure or blood cholesterol.
Mesenteric ischemia may also be caused by an embolus that suddenly blocks one of the mesenteric arteries. The emboli usually come from the heart or aorta. These clots are more commonly seen in patients witharrhythmias, such as atrial fibrillation.
Causes
Narrowing of the arteries that supply blood to the intestine causes mesenteric ischemia. The arteries that supply blood to the intestines run directly from the aorta. Mesenteric ischemia is often seen in people who have hardening of the arteries in other parts of the body (for example, those with coronary artery disease or peripheral vascular disease). The condition is more common in smokers and in patients with high blood pressure or blood cholesterol. Mesenteric ischemia may also be caused by an embolus that suddenly blocks one of the mesenteric arteries. The emboli usually come from the heart or aorta. These clots are more commonly seen in patients with arrhythmias, such as atrial fibrillation. They can be broadly classified into four categories:[1]
| Classification based on etiology | |||
|---|---|---|---|
| Etiology | Cause | Incidence | Examples |
| Occlusive causes | Aterial embolism | 50-70% |
|
| Arterial thrombosis | 15-25% |
| |
| Venous thrombosis | 5% |
| |
| Non-Occlusive causes | Non-occlusive ischemia | 20-30% |
|
Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[2]
| Class I |
| "1. Nonocclusive intestinal ischemia should be suspected in patients with low flow states or shock, especially cardiogenic shock, who develop abdominal pain. (Level of Evidence: B) " |
| "2. Nonocclusive intestinal ischemia should be suspected in patients receiving vasoconstrictor substances and medications (e.g., cocaine, ergots, vasopressin, or norepinephrine) who develop abdominal pain. (Level of Evidence: B) " |
| "3. Nonocclusive intestinal ischemia should be suspected in patients who develop abdominal pain after coarctation repair or after surgical revascularization for intestinal ischemia caused by arterial obstruction. (Level of Evidence: B) " |
References
- ↑ Reinus JF, Brandt LJ, Boley SJ (1990). "Ischemic diseases of the bowel". Gastroenterol Clin North Am. 19 (2): 319–43. PMID 2194948.
- ↑ Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 61 (14): 1555–70. doi:10.1016/j.jacc.2013.01.004. PMC 4492473. PMID 23473760.