Acute Abdomen

Ischaemic Bowel
Philomena Corrigan
Nurse Consultant Cardiac Care
Senior Lecturer Adult Nursing
 Acute Abdomen

Ischaemic Bowel
• Ischaemia more likely to affect small bowel than large
bowel
• The Superior Mesenteric Artery (SMA) supplies:
- Small bowel
- Ascending Transverse colon
- Proximal 2/3 of Transverse colon
• The Inferior Mesenteric Artery (IMA) supplies:
- Distal 1/3 of Transverse colon
- Descending colon
- Sigmoid colon
 Acute Abdomen
Ischaemic Bowel
The Splenic Flexure:
• Is the junction between the transverse and
descending colon
• Is supplied by the most distal portions of
both the IMA & SMA
• Is especially vulnerable to ischemia during
periods of systemic hypoperfusion, such
as in shock
 Acute Abdomen
Ischaemic Bowel
Due to:
• A thromboemoblism from the left side of
the heart occluding the SMA e.g. during
A.F. = transmural infarction
• Nonocclusive ischemia, such as that seen
in hypotension secondary to heart failure
= mucosal or mural infarct
• Primary mesenteric vein thromboses
precipitated by hypercoagulable states
such as polycythemia vera
 Acute Abdomen
Ischaemic Bowel
Clinical Presentation
• Diffuse abdominal pain
• Bowel distention
• Bloody diarrhoea
• Absent bowel sounds
• Neutrophilic leucocytosis (sometimes with a left
shift)
• Increased serum amylase
• Abdo X-ray shows:
- many air-fluid levels
- widespread oedema
 Leucocytosis
• An abnormally large increase in the
number of white blood cells in the blood,
often occurring during an acute infection
or inflammation
 Neutrophilic leucocytosis
• A "left shift" refers to the presence of
increased proportions of younger, less
well differentiated neutrophils and
neutrophil-precursor cells in the blood
• This generally reflects early or premature
release of myeloid cells from the bone
marrow, the site where neutrophils are
generated.
 References
• Patient UK website: Acute Abdomen