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 complete vascular occlusion, irreversible damage to the intestinal mucosa (intestinal lining) occurs.
The following forms of mesenteric ischemia can be distinguished:
- Arterial occlusive ischemia – occlusion of an artery (in 85% of all cases, the superior mesenteric artery (AMS) is involved) by an embolus (arterial embolism) or by thrombosis.
- Arterial non-occlusive ischemia (NOD; synonym: non-occlusive mesenteric ischemia, NOMI) – ischemia (reduced supply) due to cardiovascular disturbances (e.g., due to a drop in cardiac output, HZV; heart failure/cardiac insufficiency) with reactive vasospasm in the mesenteric stromal area (area of the vessels supplying the intestine)
- Venous – thrombosis of the mesentericoportal axis (a vein supplying the intestine).
Etiology (causes) of occlusive mesenteric ischemia
Behavioral causes
- Consumption of stimulants
- Tobacco (smoking) – smokers 6 times the risk compared with nonsmokers
Disease-related causes
Cardiovascular system (I00-I99)
- Arterial hypertension (high blood pressure).
- Atherosclerosis (arteriosclerosis, hardening of the arteries)
- Chronic inflammatory bowel disease (IBD)
- Heart failure (cardiac insufficiency)
- Coronary heart disease (CHD)
- Peripheral arterial occlusive disease (paVK) – progressive narrowing or occlusion of the arteries supplying the arms/ (more commonly) legs, usually due to atherosclerosis (arteriosclerosis, hardening of the arteries).
- Zust. n. Myocardial infarction (heart attack).
- Atrial fibrillation (cardiac arrhythmia)
Etiology (causes) of non-occlusive mesenteric ischemia (NOD)
Biographic causes
- Age of life – increasing age
Disease-related causes
Cardiovascular system (I00-I99)
- Peripheral and cerebrovascular vascular disease, unspecified.
- Heart failure (cardiac insufficiency)
Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99)
- Renal insufficiency (kidney weakness).
Other causes
- Chronic hemodialysis (blood washing), wg fluid deprivation with hypoemia.
- Condition after heart surgery with heart-lung machine, use of intra-aortic balloon pump.
Medication
- Digitalis – active substance used in heart failure.
Etiology (causes) of venous mesenteric ischemia
Disease-related causes.
Blood, hematopoietic organs – immune system (D50-D90).
- Thrombophilia (tendency to thrombosis), congenital (eg, AT III, protein C, -S deficiency).
Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).
- Pancreatitis (inflammation of the pancreas).
Neoplasms – tumor diseases (C00-D48)
- Hepatocellular carcinoma (HCC) (hepatocellular carcinoma).
- Pancreatic carcinoma (pancreatic cancer).
- Paraneoplastic – changes that may occur due to malignant (malignant) neoplasm.
