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Mesenteric circulation

Etiology. Mesenteric: - Acute: - Arterial (70% of all cases) - SMAE (50%) -SMAT (15-25%) -NOMI (20-30%) -Venous (5%) - ChronicColonic (most common). Predisposing factors. Arterial: Advanced age Ather

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Mesenteric circulation

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    1. Mesenteric circulation Celiac axis (Foregut): -Common hepatic -Splenic -Left gastric arteries. Superior mesenteric artery (Midgut): -Ileocolic artery -Middle colic artery -Right colic artery. Inferior mesenteric artery (Hindgut): -Left colic artery -Sigmoid arteries -Hemorrhoidal arteries

    2. Etiology Mesenteric: - Acute: - Arterial (70% of all cases) - SMAE (50%) -SMAT (15-25%) -NOMI (20-30%) -Venous (5%) - Chronic Colonic (most common)

    3. Predisposing factors Arterial: Advanced age Atherosclerosis Low cardiac output states Cardiac arrhythmias Severe cardiac valvular disease Recent myocardial infarction Intra-abdominal malignancy Vasculitis Cocaine (NOMI).

    4. Predisposing factors Venous: - Hypercoagulable states (75%). - Recurrent DVT. - Recurrent thrombophlebitis. - Contraceptive pills. - Portal hypertension. - Abdominal infection. - Malignancy. - Trauma.

    5. Predisposing factors Ischemic colitis: - Idiopathic - Diabetes Mellitus - Hemodialysis - Aortic or cardiac bypass surgery - Aortic dissection - Vasculitis - Infections e.g. E. coli - Hypercoagulable states - Medications - Hypotension - Obstructive lesions of the colon e.g. carcinoma

    6. Clinical picture Symtoms: - Acute: - Arterial: - Acute abdominal pain - Vomiting - Hematochezia and less severe pain in acute colon ischemia - Confusion in elderly

    7. Clinical picture Venous: Insidious pain Gastrointestinal bleed Anorexia Chronic (Intestinal angina): Abdominal pain (post prandial). Weight loss. Nausea, vomiting. Early satiety. Change in bowel habits

    8. Clinical picture Ischemic colitis: Acute: - Hyperactive phase:Severe lower abdominal pain, bloody loose stools - Paralytic phase: Pain decreases, becomes more continuous - Shock phase:Hypotension Distention of the colon Chronic: - Recurrent bacteremia, sepsis - Bloody diarrhea, weight loss

    9. Clinical picture Signs: - Acute - Early: severity of pain is out of proportion to the abdominal findings - Late: Peritonitis Chronic: Weight loss. Abdominal bruits in 50% of patients.

    10. Diagnostic studies Laboratory studies: - Early: Non-specific, - late: - High WBCs - High amylase. - High LDH. - High CPK. - High alkaline phosphatase.

    11. Diagnostic studies Radiologic studies: - Plain abdominal x-ray - Non-specfic, late - Exclude other causes of acute abdomen - Mesenteric vessel calcification (chronic)

    12. Diagnostic studies CT scan: - Better in cases of acute MVT. - Thickening of bowel wall. - Pneumatosis. - Gas in mesenteric veins. Duplex MRA Mesenteric angiography Laparoscopy

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