Intestinal ischemia resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]
Definition
Intestinal ischemia are a heterogeneous group of diseases characterized by hypoxia of the small bowel and/or colon, which most commonly arises from occlusion, vasospasm, and/or hypoperfusion of the mesenteric vasculature.[1] Intestinal ischemic disorders have been classified into the following three major types.[2][3]
| Clinical subgroups | Definitions |
|---|---|
| Acute mesenteric ischemia | It includes superior mesenteric artery embolism (SMAE) (50%); nonocclusive mesenteric ischemia (NOMI) (20% to 30%); superior mesenteric artery thrombosis (SMAT) (15% to 25%); and superior mesenteric vein (SMV) thrombosis (5%). It is most commonly associated with compromise of the blood flow in the superior mesenteric artery (SMA) distribution affecting all, or portions of, the small bowel and right colon. |
| Chronic mesenteric ischemia | It usually refers to intestinal angina, where the splanchnic circulation is insufficient in meeting the functional demands of the gut, but there is no loss of tissue viability. |
| Colonic ischemia (CI) | It is the most common vascular disorder of the gut that includes reversible ischemic colopathy, transient ulcerating ischemic colitis, chronic ulcerating ischemic colitis, colonic stricture, colonic gangrene, and fulminant universal ischemic colitis. |
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Intestinal ischemia itself may present or complicate as a life-threatening condition and must be treated as such irrespective of the causes.
Common Causes
- Arterial embolism
- Arterial thrombosis
- Hypercoagulable states
- Non-occlusive ischemia
- Cardiogenic shock
- Vasculitis
- Vasoconstrictors: Cocaine, ergot, vasopressin, or norepinephrine.
- Venous thrombosis
Management
The algorithm is based on the American College of Gastroenterology guidelines for management of Intestinal Ischemia in adults.
Management of Acute Mesentric Ischemia
Management of Chronic Mesentric Ischemia
Management of Colonic Ischemia
Do's
Dont's
References
- ↑ Gore RM, Thakrar KH, Mehta UK, Berlin J, Yaghmai V, Newmark GM (2008). "Imaging in intestinal ischemic disorders". Clin Gastroenterol Hepatol. 6 (8): 849–58. doi:10.1016/j.cgh.2008.05.007. PMID 18674733.
- ↑ Greenwald DA, Brandt LJ, Reinus JF (2001). "Ischemic bowel disease in the elderly". Gastroenterol Clin North Am. 30 (2): 445–73. PMID 11432300.
- ↑ Lock G (2001). "Acute intestinal ischaemia". Best Pract Res Clin Gastroenterol. 15 (1): 83–98. doi:10.1053/bega.2000.0157. PMID 11355902.