Ischemic Bowel Syndromes

Silva, José A.; White, Christopher J.

doi:10.1016/j.pop.2012.11.007

Cited by 14 publications

(15 citation statements)

References 78 publications

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“…14 During the examination, the patient's description of the history and symptoms can be unclear because of changes in mental status, particularly if he or she is elderly. 15 Differentiation between arterial and venous obstruction is not always simple; however, patients with mesenteric venous thrombosis, as compared with those with acute arterial occlusion, tend to present with a less abrupt onset of abdominal pain. 16 Risk factors for venous thrombosis that should be evaluated include a history of deep venous thrombosis, cancer, chronic liver disease or portal-vein thrombosis, recent abdominal surgery, inflammatory disease, and thrombophilia.…”

Section: Manifestations Of Acute Mesenteric Ischemiamentioning

confidence: 99%

Mesenteric Ischemia

2016

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esenteric ischemia is caused by blood flow that is insufficient to meet the metabolic demands of the visceral organs. The severity of ischemia and the type of organ involved depend on the affected vessel and the extent of collateral-vessel blood flow. Despite advances in the techniques used to treat problems in the mesenteric circulation, the most critical factor influencing outcomes in patients with this condition continues to be the speed of diagnosis and intervention. Although mesenteric ischemia is an uncommon cause of abdominal pain, accounting for less than 1 of every 1000 hospital admissions, an inaccurate or delayed diagnosis can result in catastrophic complications; mortality among patients in whom this condition is acute is 60 to 80%. 1-3 This article highlights the pathophysiological features, diagnosis, and treatment of ischemic syndromes in the foregut and intestines. The goal of this review is to improve the understanding and management of this life-threatening disorder. T y pes of Mesenter ic Ischemi a Arterial obstruction, the most common cause of mesenteric ischemia, has both acute and chronic forms. Acute mesenteric ischemia constitutes a surgical emergency. It is associated with embolic occlusion in 40 to 50% of cases (Fig. 1), with thrombotic occlusion of a previously stenotic mesenteric vessel in 20 to 35% of cases, 4 and with dissection or inflammation of the artery in less than 5% of cases. More than 90% of cases of chronic mesenteric ischemia are related to progressive atherosclerotic disease that affects the origins of the visceral vessels; treatment in such cases is focused on elective revascularization to avert the risk of complications and death associated with the development of acute ischemia (Fig. 2). Mesenteric venous thrombosis, which accounts for 5 to 15% of cases of mesenteric ischemia, results in impaired venous outflow, visceral edema, and abdominal pain. Its causes include primary or idiopathic thrombosis; however, 90% of cases are related to thrombophilia, trauma, or local inflammatory changes that may include pancreatitis, diverticulitis, or inflammation or infection in the biliary system. 5 Patients typically have a response to anticoagulation in combination with treatment for the underlying local or systemic processes. Surgical intervention is reserved for patients who are critically ill or whose condition is deteriorating; it is rarely required. The mesenteric circulation is a high-resistance vascular bed in which impaired regional perfusion owing to vasospasm can develop. The resulting ischemia is referred to as nonocclusive mesenteric ischemia. Although the incidence of nonocclusive mesenteric ischemia may be decreasing as awareness of the condition increases and as supportive therapies improve, it accounts for 5 to 15% of all cases of mesenteric ischemia. 6 It is most often associated with cardiac insufficiency

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Section: Manifestations Of Acute Mesenteric Ischemiamentioning

confidence: 99%

Mesenteric Ischemia

2016

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“…Patients often limit food intake due to postprandial pain, resulting in substantial body weight loss. 45 The goal of treatment is restoration of blood flow to the gastroduodenal mucosa, typically achieved with a vascular stent 43 or operation.…”

Section: Diagnosis and Approachmentioning

confidence: 99%

Diagnostic and Treatment Approaches for Refractory Peptic Ulcers

Kim

2015

Clin Endosc

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Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. The most common causes of refractory ulcers are persistent Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity. Serologic tests may be useful for patients currently taking proton pump inhibitors (PPIs) or for suspected false negative results, as they are not affected by PPI use. NSAID use should be discontinued when possible. Platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin. Cigarette smoking can delay ulcer healing. Therefore, patients who smoke should be encouraged to quit. Zollinger-Ellison syndrome (ZES) is a rare but important cause of refractory gastroduodenal ulcers. Fasting plasma gastrin levels should be checked if ZES is suspected. If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered.

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“…Отсутствие патог-номоничных симптомов, невысокие показатели чувствительности и специфичности лучевых, лабо-раторных методов на ранних стадиях ОНМК при-водят к промедлению с эффективными методами лечения [5].…”

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“…ОНМК в 50% случаев наступает из-за тромбоэмбо-лии, в 12% -артериального тромбоза, в 8% -ве-нозного тромбоза, в 20% причинами служат неок-клюзионные нарушения, в 10% заболевание вызва-но другими причинами [4,5]. В случае тромбоэмбо-лической окклюзии ввиду отсутствия выраженного коллатерального кровообращения наступает ранняя ишемия и последующий трансмуральный некроз.…”

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“…Больные с ОНМК требуют агрессивной реани-мации и гидратации, кроме того, коррекции мета-болического ацидоза и электролитного дисбаланса, назначения антибиотиков от грамотрицательных и анаэробных бактерий [5]. Декомпрессия через назо-гастральный зонд имеет важное значение, необхо-димо прекращать прием препаратов, вызывающих чревную вазоконстрикцию (вазопрессин, дигок-син).…”

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