TSMU_USMD, bad course

1. L a s h a C h k h i k v a d z e
U S M D 2 0 2 4

2. Anatomical overview
• mesentery - an organ that attaches the
intestines to the posterior abdominal
wall
• Important mesenteric vessels
• Celia trunk
• Superior mesenteric artery
• Inferior mesenteric artery
• SMA supplies: distal duodenum,
jejunum, ileum.
• 20-25% of cardiac output is consumed
by the intestines

3. Definition of the disease
• Mesenteric ischemia occurs when narrowed or blocked arteries restrict blood
flow to your small intestine.
• Decreased blood flow can permanently damage the small intestine.
• Acute mesenteric ischemia - Sudden loss of blood flow to
the small intestine from a blood clot .
• Chronic Mesenteric ischemia - develops over time due to
buildup of plaque that narrows the arteries.
• Untreated, chronic mesenteric ischemia can become
acute or lead to severe weight loss and malnutrition.

4. Mesenteric ischemia
chronicAcute
Arterial occlusion Venous occlusion Non-occlusive
Embolism
(40-50%)
Thrombosis
(20-30%)
Mesenteric venous
thrombosis (5-10%)
Vasoconstriction
(15-20%)

5. What happens to bowel during absolute ischemia?
15 min 3 hrs 6 hrs
A b s o l u t e i s c h e m i a

6. SYMPTOMS
Acute (early)
• Abrupt, severe
abdominal pain
• Urgent need to have a
bowel movement
• Fever
• Nausea and vomiting
Acute (late)
• Bloody diarrhea
• Abdominal
distention
• Fever, shock,
tachycardia.
Chronic
• Abdominal pain that starts
about 30 minutes after
eating
• Pain that worsens over an
hour
• Pain that goes away within
one to three hours

7. Complications
• Sepsis. the body overreacts to
the chemicals, triggering
changes that can lead to
multiple organ failure.
• Irreversible bowel
damage. parts of the bowel to
die.
• Death.
If untreated promptly
• Fear of eating.
• Unintentional weight loss.
• Acute-on-chronic
mesenteric ischemia. .
People with chronic mesenteric
ischemia can develop:

8. Blood test:
• Hemoconcentration
• Leukocytosis
• Metabolic acidosis
• Lactic acidosis
X-ray/CT
• Dilated bowel loops
• thumb – printing sign (wall
edema, thickening)
• Pneumatosis intestinalis (gas in
the wall of SI)
Dopplers USG
• Detects stenosis or
occlusion of the vessel
Angiography
Diagnostic tests

9. Dilated bowel loop Thumb printing sign
Pneumatosis intestinalis Gas in the bowel

10. Management of the disease

11. Laparotomy of the ischemic bowel and resection

12. Thank You!