Podcast
Questions and Answers
What is the most important clue to an early diagnosis of acute mesenteric ischaemia?
What is the most important clue to an early diagnosis of acute mesenteric ischaemia?
What is often revealed in investigation of acute mesenteric ischaemia?
What is often revealed in investigation of acute mesenteric ischaemia?
What is a possible treatment option for acute mesenteric ischaemia?
What is a possible treatment option for acute mesenteric ischaemia?
What is a characteristic of the pain in acute mesenteric ischaemia?
What is a characteristic of the pain in acute mesenteric ischaemia?
Signup and view all the answers
What is a common feature of the abdominal examination in acute mesenteric ischaemia?
What is a common feature of the abdominal examination in acute mesenteric ischaemia?
Signup and view all the answers
What is a possible complication of acute mesenteric ischaemia?
What is a possible complication of acute mesenteric ischaemia?
Signup and view all the answers
What is the usual treatment for fistula?
What is the usual treatment for fistula?
Signup and view all the answers
What is the common risk factor for developing an enterocutaneous fistula?
What is the common risk factor for developing an enterocutaneous fistula?
Signup and view all the answers
What is the definition of high fistula output?
What is the definition of high fistula output?
Signup and view all the answers
What is the reason for failure of spontaneous healing of fistula?
What is the reason for failure of spontaneous healing of fistula?
Signup and view all the answers
What is the percentage of small bowel enterocutaneous fistulae that develop after surgery with no small bowel resection?
What is the percentage of small bowel enterocutaneous fistulae that develop after surgery with no small bowel resection?
Signup and view all the answers
What is the eventual outcome of most fistulae?
What is the eventual outcome of most fistulae?
Signup and view all the answers
What is the recommended timing for implementing anticoagulation in the postoperative period?
What is the recommended timing for implementing anticoagulation in the postoperative period?
Signup and view all the answers
What is the usual outcome for elderly patients with chronic small intestinal ischaemia?
What is the usual outcome for elderly patients with chronic small intestinal ischaemia?
Signup and view all the answers
What is a common symptom of chronic small intestinal ischaemia?
What is a common symptom of chronic small intestinal ischaemia?
Signup and view all the answers
Why may abdominal symptoms be overlooked initially in patients with chronic small intestinal ischaemia?
Why may abdominal symptoms be overlooked initially in patients with chronic small intestinal ischaemia?
Signup and view all the answers
What is a possible treatment option for selected cases of chronic small intestinal ischaemia?
What is a possible treatment option for selected cases of chronic small intestinal ischaemia?
Signup and view all the answers
What is the underlying cause of chronic small intestinal ischaemia in most cases?
What is the underlying cause of chronic small intestinal ischaemia in most cases?
Signup and view all the answers
Why is an early return to theatre to treat the problem unlikely to succeed in a septic, malnourished patient?
Why is an early return to theatre to treat the problem unlikely to succeed in a septic, malnourished patient?
Signup and view all the answers
What is the best way to identify infected collections in patients with enterocutaneous fistulae?
What is the best way to identify infected collections in patients with enterocutaneous fistulae?
Signup and view all the answers
Why is skin protection important in patients with enterocutaneous fistulae?
Why is skin protection important in patients with enterocutaneous fistulae?
Signup and view all the answers
What is a key consideration when deciding between enteral and parenteral feeding in patients with enterocutaneous fistulae?
What is a key consideration when deciding between enteral and parenteral feeding in patients with enterocutaneous fistulae?
Signup and view all the answers
What is the goal of a sequence of contrast studies in patients with enterocutaneous fistulae?
What is the goal of a sequence of contrast studies in patients with enterocutaneous fistulae?
Signup and view all the answers
When should an anastomosis be avoided in patients with enterocutaneous fistulae?
When should an anastomosis be avoided in patients with enterocutaneous fistulae?
Signup and view all the answers
Study Notes
Mesenteric Ischaemia
- Classified into acute intestinal ischaemia and chronic mesenteric vascular disease.
- Sudden onset of severe abdominal pain is a key symptom, particularly in patients with atrial fibrillation or atherosclerosis.
- Pain typically located in the central abdomen; out of proportion to physical exam findings.
- Persistent vomiting and altered blood in stools are early indicators; mild abdominal tenderness may initially be present.
- Shock can rapidly develop, showing signs of hypovolaemia and sepsis.
- Diagnosis usually reveals profound neutrophil leukocytosis; CT scans may show absence of gas in thickened small intestine.
- Treatment options include laparotomy with embolectomy or SMA revascularization; anticoagulation postoperatively is critical.
- High mortality rate; resection of affected bowel more common in younger patients, while elderly patients may be deemed incurable.
- Intravenous alimentation often needed after extensive bowel resection, with some younger patients achieving normal digestive function.
Chronic Small Intestinal Ischaemia
- Primarily caused by atherosclerosis affecting proximal superior mesenteric and coeliac vessels.
- Patients experience severe central abdominal pain within 30-60 minutes after eating, known as mesenteric angina.
- Symptoms can lead to weight loss and diarrhea due to malabsorption; often misdiagnosed as peptic ulcer disease or IBS.
- Significant vascular disease is common in elderly patients; visceral angiography is used for diagnosis.
- Treatment typically involves selective visceral angiography with potential stenting or bypass surgery.
- Smoking cessation and anticoagulation are important components of management.
Enterocutaneous Fistula
- An abnormal connection between the small intestine and skin; most commonly related to surgical complications.
- Up to 50% of enterocutaneous fistulae develop post-surgery, primarily from anastomosis leaks or inadvertent enterotomy.
- More frequent in cases involving adhesion division during abdominal surgery.
- High-output fistulae (>500 mL effluent/day) can lead to challenging electrolyte imbalances and dehydration.
- Spontaneous healing is anticipated unless hindered by distal obstruction or abscess formation.
- Management focuses on nutritional support, fluid replacement, and skin protection due to caustic intestinal effluent.
- Decisions on enteral versus parenteral feeding depend on fistula output and anatomical considerations.
- Surgical intervention requires careful planning, especially if intra-abdominal sepsis or hypoalbuminemia is present; definitive treatment is best performed under optimal conditions.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Diagnosing and managing mesenteric ischaemia, including symptoms, classification, and risk factors. Learn about acute and chronic mesenteric vascular disease.