2.4. Intestinal Ischemia.pdf - 2022 2.4. Intestinal...

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Trans Group #:Hulipas, Lazo, Maliones, Nuñez, Ortega, Palconete, Tiwaken1of52.4. Intestinal IschemiaDR. MILBEN A. MALBOG | 03/25/20212022GASTROENTEROLOGYOUTLINEI. AcuteMesentericIschemiaA. CausesB. ClinicalFeaturesC. PhysicalExaminationD. DiagnosisII. ColonicIschemiaA. CausesB. Patho-physiologyC. ClinicalFeaturesD. DiagnosisE. TreatmentIII. ChronicMesentericInsufficiencyA. ClinicalfeaturesB. DiagnosisC. TreatmentIV. VacsulitisA. EtiologyB. Patho-genesisC. TreatmentLEGENDRememberLecturerBookPrevious TransPresentationHELLOLEARNING OBJECTIVESTo define intestinal ischemiaTo know the different types of intestinal ischemia as to:Etiology and risk factorsDiagnostic work-upPrognosisTreatmentINTESTINAL ISCHEMIAEnd result of interruption or reduction of blood supply to theintestinesDeprivation of oxygen and nutrients needed for cellular integrityUncommon disease with high mortalitySigns and symptoms range from mild, chronic to catastrophicepisodesTYPESand FREQUENCYColonic ischemia - 70-75%Acute mesenteric ischemia: 20-25%Focal segmental ischemia: 5%Chronic mesenteric insufficiency 5%I. ACUTE MESENTERIC ISCHEMIAA. CAUSES OF ACUTE MESENTERIC ISCHEMIASuperior mesenteric artery embolus - 50%Non-occlusive mesenteric ischemia - 25%Superior mesenteric artery thrombus - 10%%Mesenteric venous thrombosis -10%Focal segmental ischemia- 5%MESENTERIC CIRCULATIONB. CLINICAL FEATURES>50 years of ageLong standing CHFCardiac ArrhythmiasRecent MI or hypotensionYoung patients who take vaso-active drugs or havethrombophiliaAbdominal painNausea, vomiting, diarrheaUnexplained abdominal distentionGI bleeding(+) occult blood - 75%seem thru microscopeMaroon or bright red stoolrareMental confusionC. PHYSICAL EXAMINATIONEarly - normalLate- peritonitis and cardiovascular collapseSUPERIOR MESENTERIC ARTERY EMBOLUSUsually comes from left atrium or ventricular mural thrombusLodge preferentially distal to the origin of middle colic arteryfrom SMANON-OCCLUSIVE MESENTERIC ISCHEMIAPrecipitating causesAcute myocardial infarctionCongestive heart failureArrhythmiasShock
Trans Group #:Hulipas, Lazo, Maliones, Nuñez, Ortega, Palconete, Tiwaken2of52.4. Intestinal IschemiaDR. MILBEN A. MALBOG | 03/25/20212022GASTROENTEROLOGYCirrhosisChronic kidney disease (esp. If with hemodialysis)SUPERIOR MESENTERIC ARTERY THROMBOSISWith evidence of cerebrovascular, coronary or peripheral arterialinsufficiencyAccelerated atherosclerosisMaybe superimposed on symptoms of chronic mesentericischemia(+) History of Post Prandial and Weight lossMESENTERIC VENOUS THROMBOSISHYPERCOAGULABLE STATEACTIVATED PROTEIN RESISTANCEANTI-THROMBIN DEFICINECYPROTEIN C AND S DEFICIENCYMETHYLTERAHYDROFOLATE DEFICIENCYESTROGEN USE (OC, HRT)POLCYTHEMIA VERATHROMBOCYTOSISNEOPLASMSPERIPHERAL DVTPREGNANCYPORTAL HYPERTENSIONCIRRHOSIS, CONGESTIVE HEPATOMGELYAFTER SCLEROTHERAPY OF ESOPHAGEALVARICESPOST OPRATIVE STATE OR TRAUMA

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Term
Fall
Professor
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Tags
Bowel obstruction, Superior Mesenteric Artery, Intestinal Ischemia

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