Mesenteric ischemia medical therapy: Difference between revisions

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{{Mesenteric ischemia}}
{{CMG}} {{AE}} {{FT}}
{{CMG}} {{AE}} {{FT}}
==Overview==
==Overview==

Revision as of 19:13, 29 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Mesenteric ischemia is a medical emergency and requires prompt treatment. The mainstay of treatment is surgery if bowel necrosis or gangrene has occurred , whereas medical therapy is considered initially for hemodynamically unstable patients.

Medical Therapy

  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Pharmacologic medical therapies for mesenteric ischemia include heparin, [therapy 2], and/or [therapy 3].
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Initial management:

Mesenteric ischemia is an acute emergency condition that requires prompt intervention. The outline of initial medical management of all types of meseneteric ischemia includes:

  • Pain control
  • Fluid resuscitation
  • Hemodynamic support and monitoring
  • Correction of electrolyte abnormalities
  • Anticoagulation
  • Broad sprectrum antibiotics
  • Gastrointestinal decompression

Cause specific management of mesenteric ischemia:

Etiology Management
Superior mesenteric artery embolism
  • Embolectomy of superior mesenteric artery
  • Anticoagulation
  • Assesment of bowel viability
  • Resect bowel if necrosis has occurred
Mesenteric arterial thrombosis
  • Anticoagulation
  • Endovascular techniques when possible
  • Aorto-mesenetric bypass
  • Reassessment for bowel viability
  • Resection if there is bowel necrosis
Non occlusive mesenteric ischemia
  • Palpation of proximal vessels for patency

Further

Multimodal management of mesenteric ischemia
Early management Late management
Pathophysiological events Vascular occlusion Splanchnic hypoperfusion Intestinal hypoxia
  • Intestinal barrier injury
  • Translocation
  • Local inflammatory pathway
Systemic inflammatory pathways Necrosis

Organ failure

Treatment strategy
  • Heparin
  • Aspirin
  • Revascularization
  • Oxygen
  • Blood volume resuscitation
  • Transfusion
Oral antibiotics Intravenous antibiotics Intestinal resection

Disease Name