Mesenteric ischemia medical therapy: Difference between revisions
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'''Initial management:''' | '''Initial management:''' | ||
Mesenteric ischemia is an acute emergency condition that requires prompt intervention. The outline of initial medical management of all types of meseneteric ischemia includes:<ref name="pmid9068664">{{cite journal| author=Klempnauer J, Grothues F, Bektas H, Pichlmayr R| title=Long-term results after surgery for acute mesenteric ischemia. | journal=Surgery | year= 1997 | volume= 121 | issue= 3 | pages= 239-43 | pmid=9068664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9068664 }} </ref><ref name="pmid23103820">{{cite journal| author=Corcos O, Castier Y, Sibert A, Gaujoux S, Ronot M, Joly F et al.| title=Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. | journal=Clin Gastroenterol Hepatol | year= 2013 | volume= 11 | issue= 2 | pages= 158-65.e2 | pmid=23103820 | doi=10.1016/j.cgh.2012.10.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23103820 }} </ref> | Mesenteric ischemia is an acute emergency condition that requires prompt intervention. The outline of initial medical management of all types of meseneteric ischemia includes:<ref name="pmid9068664">{{cite journal| author=Klempnauer J, Grothues F, Bektas H, Pichlmayr R| title=Long-term results after surgery for acute mesenteric ischemia. | journal=Surgery | year= 1997 | volume= 121 | issue= 3 | pages= 239-43 | pmid=9068664 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9068664 }} </ref><ref name="pmid23103820">{{cite journal| author=Corcos O, Castier Y, Sibert A, Gaujoux S, Ronot M, Joly F et al.| title=Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. | journal=Clin Gastroenterol Hepatol | year= 2013 | volume= 11 | issue= 2 | pages= 158-65.e2 | pmid=23103820 | doi=10.1016/j.cgh.2012.10.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23103820 }} </ref><ref name="pmid20298945">{{cite journal| author=Wyers MC| title=Acute mesenteric ischemia: diagnostic approach and surgical treatment. | journal=Semin Vasc Surg | year= 2010 | volume= 23 | issue= 1 | pages= 9-20 | pmid=20298945 | doi=10.1053/j.semvascsurg.2009.12.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20298945 }} </ref> | ||
* Supplemental oxygen | * Supplemental oxygen | ||
Revision as of 23:18, 5 January 2018
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Mesenteric ischemia Microchapters |
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Mesenteric ischemia medical therapy On the Web |
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Risk calculators and risk factors for Mesenteric ischemia medical therapy |
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 medical emergency and requires prompt treatment. The mainstay of treatment is surgery if bowel necrosis or gangrene has occurred , whereas medical therapy is considered initially for hemodynamically unstable patients.
Medical Therapy
The treatment of choice, medical versus surgical in mesenteric ischemia depends on three key elements:
- Duration and severity of ischemia of the intestine
- Nature of the occlusive lesion
- Availability of the immediate surgical or interventional radiology facility in the emergency room
- Hemodyanamic stability of the patient
Pharmacological therapy:
Pharmacologic medical therapies for mesenteric ischemia in patients who are hemodynamically stable and no evidence of bowel ischemia include the following
Initial management:
Mesenteric ischemia is an acute emergency condition that requires prompt intervention. The outline of initial medical management of all types of meseneteric ischemia includes:[1][2][3]
- Supplemental oxygen
- Pain control
- Fluid resuscitation
- Hemodynamic support and monitoring
- Correction of electrolyte abnormalities
- Anticoagulation with heparin, to limit thrombus propagation
- Broad sprectrum antibiotics
- Gastrointestinal decompression
- Avoidance of vasopressors, which can exacerbate ischemia
- Proton pump inhibitors
Management according to the severity of presentation:
Acute embolic mesenteric ischemia is managed according to the hemodyanamic stabilty or the presence/abscene of peritoneal signs.
| Embolic mesenteric arterial occlusion | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Anticoagualation with heparin Pain management | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Peritoneal signs | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Computed tomographic angiography | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Embolus present | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Thrombolysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Repeat imaging Resolution of thrombus and no persistent symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | B03 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| C03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| D02 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| B01 | B02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| C01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| B01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| A01 | A02 | A03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| B01 | B02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| C01 | C02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| D01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| E01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| D01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multimodal management of mesenteric ischemia | ||||||
|---|---|---|---|---|---|---|
| Early management | Late management | |||||
| Pathophysiological events | Vascular occlusion | Splanchnic hypoperfusion | Intestinal hypoxia |
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Systemic inflammatory pathways | Necrosis
Organ failure |
| Treatment strategy |
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Oral antibiotics | Intravenous antibiotics | Intestinal resection | |
Disease Name
- ↑ Klempnauer J, Grothues F, Bektas H, Pichlmayr R (1997). "Long-term results after surgery for acute mesenteric ischemia". Surgery. 121 (3): 239–43. PMID 9068664.
- ↑ Corcos O, Castier Y, Sibert A, Gaujoux S, Ronot M, Joly F; et al. (2013). "Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure". Clin Gastroenterol Hepatol. 11 (2): 158–65.e2. doi:10.1016/j.cgh.2012.10.027. PMID 23103820.
- ↑ Wyers MC (2010). "Acute mesenteric ischemia: diagnostic approach and surgical treatment". Semin Vasc Surg. 23 (1): 9–20. doi:10.1053/j.semvascsurg.2009.12.002. PMID 20298945.