Medical history (history of illness) represents an important component in the diagnosis of mesenteric ischemia (bowel infarction). Family history What is the general health status of your family members? Are there any diseases in your family that are common? Are there any hereditary diseases in your family? Social history What is your profession? Current medical … Intestinal Infarction (Mesenteric Infarction): Medical History
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99) Acute abdomen (see there)
The following are the major diseases or complications that may be contributed to by mesenteric infarction (bowel infarction): Infectious and parasitic diseases (A00-B99). Sepsis (blood poisoning) Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93). Intestinal gangrene with transit peritonitis – damage to the intestine due to inadequate supply leading to peritonitis. Ileus (intestinal obstruction) … Intestinal Infarction (Mesenteric Infarction): Complications
Staging of abdominal arterial occlusive disease. Stage Findings I Asymptomatic stage (detectable only by duplex sonography or angiography) II Angina abdominalis (postprandial/after-meal abdominal pain) III Abdominal persistent pain; malabsorption syndrome; possibly ischemic colitis (inflammation of the bowel due to reduced blood flow) IV Acute mesenteric artery occlusion with mesenteric infarction
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing): Skin, mucous membranes and sclerae (white part of the eye). Gait (fluid, limping). Body posture (upright, bent over, gentle posture). Abdomen (abdomen) Shape of the abdomen? Skin color? Skin … Intestinal Infarction (Mesenteric Infarction): Examination
The following symptoms and complaints may indicate mesenteric infarction (bowel infarction): Symptoms of acute arterial mesenteric ischemia (arterial occlusive); course often in three phases: Initial stage with sudden onset of crampy abdominal pain (very severe abdominal pain); distended abdomen, soft and doughy Painless or asymptomatic interval of circa 6-12 hours (due toZugrundegehen the intramural (“located … Intestinal Infarction (Mesenteric Infarction): Symptoms, Complaints, Signs
Pathogenesis (development of disease) Mesenteric ischemia refers to acute occlusion of blood vessels supplying the intestine (= final stage of abdominal arterial occlusive disease). In approximately 85% of cases, the superior mesenteric artery is affected. In venous mesenteric ischemia, small bowel infarction does not occur until the portal vein is thrombosed. Within six hours of … Intestinal Infarction (Mesenteric Infarction): Causes
General measures Intensive medical therapy (including fluid substitution to stabilize hemodynamics; anticoagulation (inhibition of blood clotting) to prevent exacerbation (worsening of symptoms) of thromboembolic occlusive processes; antibiotic therapy). Review of permanent medication due topossible impact on the existing disease. Interventional therapeutic procedures for arterial mesenteric ischemia Transfemoral (access via an artery in the groin) aspiration … Intestinal Infarction (Mesenteric Infarction): Therapy
Laboratory parameters of 1st order – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood sugar) Blood gas analysis (BGA) Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT), alkaline phosphatase, bilirubin. Renal parameters – urea, creatinine, cystatin … Intestinal Infarction (Mesenteric Infarction): Test and Diagnosis
Therapeutic target Avoidance of complications Therapy recommendations Intensive medical therapy (ensuring vital functions): Intravascular (“into” a vessel) fluid substitution to stabilize hemodynamics (blood flow). Anticoagulation (inhibition of blood clotting) with heparin to prevent exacerbation (“worsening”) of thromboembolic occlusive processes Antibiotic therapy In non-occlusive mesenteric ischemia (NOD; ischemia (reduced supply) due to cardiovascular disturbances (e.g., due … Intestinal Infarction (Mesenteric Infarction): Drug Therapy
Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasonography of abdominal organs) [is not appropriate as a method of investigation in intestinal ischemia]. X-ray abdominal survey [rapid detection (finding) of free air, thus a valuable differential diagnostic clue → hollow organ perforation] Computed tomography (CT) of the abdomen (abdominal CT) or CT angiography – showing blood vessels. … Intestinal Infarction (Mesenteric Infarction): Diagnostic Tests
If mesenteric ischemia (arterial) and peritonitis (inflammation of the peritoneum) are suspected, immediate laparotomy (surgical opening of the abdomen) is indicated. If peritonitis is not present, the diagnosis of mesenteric ischemia must be confirmed by CT/CT angiography. Caveat. The ischemia tolerance time (time of reduced blood flow that is tolerated) of the intestine is only … Intestinal Infarction (Mesenteric Infarction): Surgical Therapy