Sandbox:Feham

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 type of intestinal ischemia primarily affecting the small intestine. It is one of the life-threatening gastrointestinal vascular emergencies which requires prompt surgical/medical intervention depending upon the underlying cause.

Common causes in the development of mesenteric ischemia can be divided into occlusive/non-occlusive, arterial or venous, localized/generalized and superficial or transmural.

Risk Factors

Common Risk Factors

Risk factors
Occlusive	Embolic	Atrial fibrillation
		Cardiac arrhythmia
		Valvular heart disease
		Infective endocarditis
		Recent myocardial infarction
		Ventricular aneurysm
		Aortic atherosclerosis
	Thrombotic	Advanced age
		Low cardiac output states
		Peripheral arterial disease
		Traumatic injury
		Inherited thrombophilia- Factor V Leidin mutation Prothrombin G20210A mutation Protein S deficiency Antithrombin III deficiency Activated protein C resistance Anti-phospholipid syndrome Myeloproliferative disorders(JAK2 V617F) mutation.
		Acquired thrombophilia- malignancy, oral contraceptives intake.
Non-occlusive		Heart failure
		Aortic insufficiency
		Septic shock
		Vasoconstrictive drugs: Digoxin Alpha-adrenergic agonists
		Cocaine abuse or ergot poisoning
		Hemodialysis

• Common risk factors in the development of mesenteric ischemia include:
  • Non-modifiable causes**
    • Age >60 years
    • High cholesterol levels
    • History of smoking
  • Occlusive causes
    • Embolic causes:
    • Atrial fibrillation
    • Cardiac arrhythmias
    • Valvular heart diseases
    • Infective endocarditis
    • Recent myocardial infarction
    • Ventricular aneurysm
    • Aortic atherosclerosis
    • Aortic aneurysm
  • Thrombotic causes:
    • Advanced age
    • Low cardiac output states
    • Traumatic injury
    • Peripheral artery disease
• Non-occlusive causes:
  • Heart failure
  • Aortic insufficiency
  • Septic shock
  • Vasoconstrictive drugs(e.g. Digoxin, alpha-adrenergic agonists)

• • Cocaine abuse or ergot poisoning

• • Hemodialysis

Less Common Risk Factors

• Less common risk factors in the development of [disease name] include:
  • [Risk factor 1]
  • [Risk factor 2]
  • [Risk factor 3]

Causes

Mesenteric ischemia may be caused by the processes that compromise the blood flow to the small intestines. Any factor that can compromise the blood supply to the affected organ; either by reducing the perfusion( low blood pressure or vasoconstriction) or by promoting the formation of thromboemboli(blood clots).It can be classified according to the time course of onset, quality of symptoms and the degree to which the blood flow is compromised. The most commom cause of mesenteric ischemia is superior mesneteric artery occlusion.

• Arterial thrombosis
• Arterial embolism
• Venous thrombosis
• Non-occlusive ischemia

Classification based on etiology
Etiology	Cause	Incidence	Risk factors
Occlusive causes	Aterial embolism	50-70%	Arrhythmia Myocardial infarction Infective endocarditis Valvular heart diseases Ventricular aneurysms History of embolic events Recent angiography
	Arterial thrombosis	15-25%	Advnaced age Prlonged hypotension Hypercoagulabilty states Estrogen Peripheral arterial disease Traumatic injury
	Venous thrombosis	5%	Right-sided heart failure Previous deep venous thrombosis Primary clotting disorder Pancreatitis Polycythemia Sickle cell anemia Recent abdominal surgery or infection
Non-Occlusive causes	Non-occlusive ischemia	20-30%	Hypovolemia Low cardiac output states Vasoconstrictive drugs (Digoxin, alpha-adrernergic agonists) Septic schock Aortic insufficiency Cocaine abuse or ergot poisoning

Life-threatening Causes[edit | edit source] Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of disease name, however complications resulting from untreated disease name is common. Life-threatening causes of [symptom/manifestation] include [cause1], [cause2], and [cause3]. [Cause] is a life-threatening cause of [disease]. Common Causes[edit | edit source] [Disease name] may be caused by: