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Mesenteric ischemia is a type of intestinal ischemia primarily affecting the small intestine. It is one of the life-threatening gastrointestinal vascular emergencies which requires prompt surgical/medical intervention depending upon the underlying cause.
Mesenteric ischemia is a type of intestinal ischemia primarily affecting the small intestine. It is one of the life-threatening gastrointestinal vascular emergencies which requires prompt surgical/medical intervention depending upon the underlying cause.


Common causes in the development of mesenteric ischemia can be divided into occlusive/non-occlusive, arterial/venous, localized/generalized and superficial/transmural.<ref name="pmid24160929">{{cite journal| author=Corcos O, Nuzzo A| title=Gastro-intestinal vascular emergencies. | journal=Best Pract Res Clin Gastroenterol | year= 2013 | volume= 27 | issue= 5 | pages= 709-25 | pmid=24160929 | doi=10.1016/j.bpg.2013.08.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24160929  }} </ref>
Common causes in the development of mesenteric ischemia can be divided into occlusive/non-occlusive, arterial or venous, localized/generalized and superficial or transmural.<ref name="pmid24160929">{{cite journal| author=Corcos O, Nuzzo A| title=Gastro-intestinal vascular emergencies. | journal=Best Pract Res Clin Gastroenterol | year= 2013 | volume= 27 | issue= 5 | pages= 709-25 | pmid=24160929 | doi=10.1016/j.bpg.2013.08.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24160929  }} </ref>


==Risk Factors==
==Risk Factors==
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!
!
|-
|-
| rowspan="12" |Occlusive
| rowspan="14" |Occlusive
| rowspan="8" |Embolic
| rowspan="8" |Embolic
|Atrial fibrillation
|[[Atrial fibrillation]]
|-
|-
|Cardiac arrhythmia
|[[Cardiac arrhythmia]]
|-
|-
|Cardiac valvular diseases
|[[Valvular heart disease]]
|-
|-
|Infective endocarditis
|[[Infective endocarditis]]
|-
|-
|Recent myocardial infarction
|Recent [[myocardial infarction]]
|-
|-
|Ventricular aneurysm
|[[Ventricular aneurysm]]
|-
|-
|Aortic atherosclerosis
|Aortic atherosclerosis
|-
|-
|Aortic aneurysm
|[[Aortic aneurysm]]
|-
|-
| rowspan="4" |Thrombotic
| rowspan="6" |Thrombotic
|Advanced age
|Advanced age
|-
|-
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|Traumatic injury  
|Traumatic injury  
|-
|-
| rowspan="6" |Non-occlusive
|Inherited thrombophilia-
|
* Factor V Leidin mutation
* Prothrombin G20210A mutation
* Protein S deficiency
 
* Antithrombin III deficiency
* Activated protein C resistance
* Anti-phospholipid syndrome
* Myeloproliferative disorders(JAK2 V617F) mutation.
|-
|Acquired thrombophilia- malignancy, oral contraceptives intake.
|-
| colspan="2" rowspan="6" |Non-occlusive
|Heart failure
|Heart failure
|-
|-
|
|Aortic insufficiency
|Aortic insufficiency
|-
|-
|
|Septic shock  
|Septic shock  
|-
|-
|
|Vasoconstrictive drugs:
|Vasoconstrictive drugs (digoxin,alpha-adrenergic agonists)
* Digoxin
* Alpha-adrenergic agonists
|-
|-
|
|Cocaine abuse or ergot poisoning
|Cocaine abuse/ergot poisoning
|-
|-
|
|Hemodialysis
|Hemodialysis
|-
|-
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|}
|}
*Common risk factors in the development of mesenteric ischemia include:
*Common risk factors in the development of mesenteric ischemia include:
*'''Occlusive causes'''
**'''Occlusive causes'''
*'''Embolic causes''':<ref name="pmid10917470">{{cite journal| author=Fitzgerald T, Kim D, Karakozis S, Alam H, Provido H, Kirkpatrick J| title=Visceral ischemia after cardiopulmonary bypass. | journal=Am Surg | year= 2000 | volume= 66 | issue= 7 | pages= 623-6 | pmid=10917470 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10917470  }} </ref>
***'''Embolic causes''':<ref name="pmid10917470">{{cite journal| author=Fitzgerald T, Kim D, Karakozis S, Alam H, Provido H, Kirkpatrick J| title=Visceral ischemia after cardiopulmonary bypass. | journal=Am Surg | year= 2000 | volume= 66 | issue= 7 | pages= 623-6 | pmid=10917470 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10917470  }} </ref>
*Atrial fibrillation  
***Atrial fibrillation  
*Cardiac arrhythmias  
***Cardiac arrhythmias  
*Cardiac valvular diseases
***Valvular heart diseases
*Infective endocarditis  
***Infective endocarditis  
*Recent myocardial infarction
***Recent myocardial infarction
*Ventricular aneurysm
***Ventricular aneurysm
*Aortic atherosclerosis   
***Aortic atherosclerosis   
*Aortic aneurysm
***Aortic aneurysm
*'''Thrombotic causes''':<ref name="pmid9746774">{{cite journal| author=Martinelli I, Mannucci PM, De Stefano V, Taioli E, Rossi V, Crosti F et al.| title=Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families. | journal=Blood | year= 1998 | volume= 92 | issue= 7 | pages= 2353-8 | pmid=9746774 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9746774  }} </ref>              
**'''Thrombotic causes''':<ref name="pmid9746774">{{cite journal| author=Martinelli I, Mannucci PM, De Stefano V, Taioli E, Rossi V, Crosti F et al.| title=Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families. | journal=Blood | year= 1998 | volume= 92 | issue= 7 | pages= 2353-8 | pmid=9746774 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9746774  }} </ref>
*Advanced age
***Advanced age
*Low cardiac output states
***Low cardiac output states
*Traumatic injury
***Traumatic injury
*Peripheral artery disease
***Peripheral artery disease
*'''Non-occlusive causes:'''<ref name="pmid16476108">{{cite journal| author=Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M| title=Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors. | journal=J Intern Med | year= 2006 | volume= 259 | issue= 3 | pages= 305-13 | pmid=16476108 | doi=10.1111/j.1365-2796.2006.01613.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16476108  }} </ref>
*'''Non-occlusive causes:'''<ref name="pmid16476108">{{cite journal| author=Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M| title=Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors. | journal=J Intern Med | year= 2006 | volume= 259 | issue= 3 | pages= 305-13 | pmid=16476108 | doi=10.1111/j.1365-2796.2006.01613.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16476108  }} </ref>
*Heart failure
**Heart failure
*Aortic insufficiency
**Aortic insufficiency
*Septic shock
**Septic shock
*Vasoconstrictive drugs(e.g. Digoxin, alpha-adrenergic agonists)
**Vasoconstrictive drugs(e.g. Digoxin, alpha-adrenergic agonists)
*Cocaine abuse/ergot poisoning
**Cocaine abuse/ergot poisoning
*Hemodialysis
**Hemodialysis


===Less Common Risk Factors===
===Less Common Risk Factors===

Revision as of 21:13, 16 November 2017


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


Overview

Mesenteric ischemia is a type of intestinal ischemia primarily affecting the small intestine. It is one of the life-threatening gastrointestinal vascular emergencies which requires prompt surgical/medical intervention depending upon the underlying cause.

Common causes in the development of mesenteric ischemia can be divided into occlusive/non-occlusive, arterial or venous, localized/generalized and superficial or transmural.[1]

Risk Factors

  • Mesenteric ischemia can be caused by any factor that can compromise the blood supply to the affected organ; either by reducing the perfusion or by promoting the formation of thromboemboli. It can be broadly classified as occlusive and non-occlusive.
  • The most potent risk factor in the development of mesenteric ischemia is superior mesenteric artery occlusion.

Common Risk Factors

Common risk factors
Occlusive Embolic Atrial fibrillation
Cardiac arrhythmia
Valvular heart disease
Infective endocarditis
Recent myocardial infarction
Ventricular aneurysm
Aortic atherosclerosis
Aortic aneurysm
Thrombotic Advanced age
Low cardiac output states
Peripheral arterial disease
Traumatic injury
Inherited thrombophilia-
  • Factor V Leidin mutation
  • Prothrombin G20210A mutation
  • Protein S deficiency
  • Antithrombin III deficiency
  • Activated protein C resistance
  • Anti-phospholipid syndrome
  • Myeloproliferative disorders(JAK2 V617F) mutation.
Acquired thrombophilia- malignancy, oral contraceptives intake.
Non-occlusive Heart failure
Aortic insufficiency
Septic shock
Vasoconstrictive drugs:
  • Digoxin
  • Alpha-adrenergic agonists
Cocaine abuse or ergot poisoning
Hemodialysis
  • Common risk factors in the development of mesenteric ischemia include:
    • Occlusive causes
      • Embolic causes:[2]
      • Atrial fibrillation
      • Cardiac arrhythmias
      • Valvular heart diseases
      • Infective endocarditis
      • Recent myocardial infarction
      • Ventricular aneurysm
      • Aortic atherosclerosis
      • Aortic aneurysm
    • Thrombotic causes:[3]
      • Advanced age
      • Low cardiac output states
      • Traumatic injury
      • Peripheral artery disease
  • Non-occlusive causes:[4]
    • Heart failure
    • Aortic insufficiency
    • Septic shock
    • Vasoconstrictive drugs(e.g. Digoxin, alpha-adrenergic agonists)
    • Cocaine abuse/ergot poisoning
    • Hemodialysis

Less Common Risk Factors

  • Less common risk factors in the development of [disease name] include:
    • [Risk factor 1]
    • [Risk factor 2]
    • [Risk factor 3]

References

  1. ↑ Corcos O, Nuzzo A (2013). "Gastro-intestinal vascular emergencies". Best Pract Res Clin Gastroenterol. 27 (5): 709–25. doi:10.1016/j.bpg.2013.08.006. PMID 24160929.
  2. ↑ Fitzgerald T, Kim D, Karakozis S, Alam H, Provido H, Kirkpatrick J (2000). "Visceral ischemia after cardiopulmonary bypass". Am Surg. 66 (7): 623–6. PMID 10917470.
  3. ↑ Martinelli I, Mannucci PM, De Stefano V, Taioli E, Rossi V, Crosti F; et al. (1998). "Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families". Blood. 92 (7): 2353–8. PMID 9746774.
  4. ↑ Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M (2006). "Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors". J Intern Med. 259 (3): 305–13. doi:10.1111/j.1365-2796.2006.01613.x. PMID 16476108.

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References

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