Natalia

Stelson

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Mesenteric venous thrombosis (MVT) Acute mesenteric arterial thrombosis (AMAT) Acute mesenteric arterial embolus (AMAE) Nonocclusive mesenteric ischemia (NOMI) Occlusive mesenteric ischemia =

Emboli

- cardiac thrombi - MI - Atrial fibrillation - valvular disease Thrombi - aorta dissection - atherosclerosis - heart failure with low cardiac output

Caused by all low-flow states - congestive heart failure - sepsis - cocaine use ( vasoconstriction) Hypercoagulation - protein C, protein S deficiency - pregnancy - cancer - infection - predisposition to the thrombi

Severe poor localized abdominal pain without abdominal signs Emboli - abrupt NOMI subacute ( several days) Diarrhea -50% Vomit, nausea - can present Bloody stool can present

20-50%

before AMI Pain during 3h after meal Changing stool Early satiety Weight loss

Lab nonspecific before complication X-ray not helpful CT angiography - sensitivity 96-100% - specificity 89-94% Ultrasound - sensitivity 92-100% - specificity 70-89% MRI =CT angiography Traditional angiography ( lateral angiogram)

 Admission

to ICU ( intensive care

unit) Fluid restitution Improving cardiac parameters Broad spectrum antibiotics Pain relief Consultation of vascular surgeon

Papaverin infusion (NOMI) Surgical embolectomy Arterial thrombolysis Bypass grafting Stenting Anticoagulation