Materiały źródłowe

• #1 Mesenteric ischemia: Recognizing an uncommon disorder and distinguishing among its causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/9/545

  Mesenteric ischemia occurs because of inadequate intestinal blood flow. […] Early recognition and intervention are key to preventing morbidity and mortality. […] Early recognition and treatment are imperative to improve patient outcomes. […] A high index of suspicion is critical to making the diagnosis and restoring blood flow, thereby improving patient outcomes. […] A careful patient history should aim to identify patients with atherosclerotic risk factors and those reporting weight loss. The diagnosis is further supported by radiographic findings of high-grade stenosis or occlusion of at least 2 mesenteric vessels. […] Early recognition and focused evaluation are crucial for timely diagnosis and prevention of catastrophic complications.

• #2 Treatment of Intestinal Ischemia – The University of Chicago MALS Program

  https://www.ucmals.com/treatment-of-intestinal-ischemia/

  Early diagnosis and prompt treatment are crucial in managing intestinal ischemia. […] The primary goal of treatment is to restore blood flow to the affected area and prevent further damage. […] In less severe cases or as a follow-up to surgery, medical management may be used to improve blood flow and prevent complications. […] Rehabilitation and long-term management are also important aspects of treating intestinal ischemia. […] Lifestyle modifications such as quitting smoking and managing underlying conditions like diabetes and high blood pressure can also help reduce the risk of future episodes. […] The treatment of intestinal ischemia requires a multidisciplinary approach involving surgery, medication, and lifestyle modifications. […] Early intervention is essential to prevent irreversible damage and improve outcomes.

• #3 Preventing Mesenteric Ischemia | NYU Langone Health

  https://nyulangone.org/conditions/mesenteric-ischemia/prevention

  At NYU Langone, our cardiologists provide information and education about lifestyle changes that can decrease your chances of developing mesenteric ischemia. […] One of the best ways to prevent or halt the progression of atherosclerosis, which can lead to mesenteric ischemia, is to quit smoking. […] High blood pressure defined as 140/90 mmHG or higher can cause arteries to become stiff and narrow, reducing blood flow. […] Unhealthy levels of cholesterol can lead to a full or partial blockage of the arteries. […] People with uncontrolled diabetes are prone to developing blockages in the arteries, which can lead to coronary artery disease and heart attack risk factors for mesenteric ischemia. […] A healthy diet and regular exercise can help control diabetes.

• #4 Mesenteric Ischemia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23246-mesenteric-ischemia

  There are several things you can do to reduce your risk of developing mesenteric ischemia. Most of them involve preventing or avoiding conditions that can make mesenteric ischemia more likely. […] The things you can do include: […] Get an annual checkup. Also known as a physical or wellness visit, this is a simple yearly visit with your healthcare provider, who can catch many of the early warning signs of heart disease, high blood pressure, high cholesterol and more. Catching these conditions before you have symptoms can make a huge difference in preventing much worse problems, including mesenteric ischemia. […] Quit tobacco. This includes vaping and smokeless tobacco products. If you dont use tobacco, dont start. Tobacco use damages your blood vessels and makes problems like mesenteric ischemia much more likely to happen.

• #5 Mesenteric artery ischemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001156.htm

  The following lifestyle changes can reduce your risk for narrowing of the arteries: […] Quit smoking. […] Keep your blood cholesterol and blood sugar under control. […] Follow a healthy diet. […] Get regular exercise. […] Get heart rhythm problems treated.

• #6 Mesenteric Ischemia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23246-mesenteric-ischemia

  Take your medications. If you have high blood pressure, high cholesterol or diabetes, taking your medication helps prevent damage that can lead to mesenteric ischemia. […] Eat a healthy, balanced diet. Many of the issues that can lead to mesenteric ischemia are related to your weight and your diet. Diets that are too high in fat or sodium can increase your cholesterol and blood pressure, both of which are risk factors for mesenteric ischemia. […] Stay active. Physical activity is important for the health of your heart and circulatory system and for maintaining a healthy weight. […] Most of the actions that will help prevent mesenteric ischemia are the same steps that can reduce your risk. Unfortunately, there will be some cases especially those involving injuries or conditions where your blood clots too easily where prevention isnt possible.

• #7 FloridaHealthFinder | Small intestinal ischemia and infarction | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/001151

  Preventive measures include: […] Controlling risk factors, such as irregular heartbeat, high blood pressure, and high cholesterol […] Not smoking […] Eating a nutritious diet […] Quickly treating hernias.

• #8 Chronic Mesenteric Ischemia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/chronic-mesenteric-ischemia

  Chronic mesenteric ischemia is a condition in which plaque builds up in the major arteries including the celiac and superior mesenteric arteries that supply blood to the small intestine or small bowel. […] The goal of chronic mesenteric ischemia treatment is to restore blood flow to your intestines before damage occurs. […] Making changes to your diet with the help of a dietitian may be the only treatment you need. […] If diet changes do not help and symptoms cause weight loss, long-term abdominal pain, and even food fear your doctor at the UPMC Heart and Vascular Institute may recommend minimally invasive or open surgical treatments to increase blood flow to your intestines. […] Decreasing the risk of atherosclerosis the condition that causes chronic mesenteric ischemia. […] Quitting smoking. […] Controlling blood sugars in people with diabetes. […] Lowering cholesterol levels. […] Lowering high blood pressure. […] Taking anti-platelet medications, such as aspirin and clopidogrel (Plavix).

• #9 Ischemic colitis: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/322162

  It may be possible for people to reduce their chances of developing chronic ischemic colitis. For example, because smoking is a risk factor for this condition, avoiding tobacco smoke can make ischemic colitis less likely. […] Preventing those conditions can also help avoid ischemic colitis. […] Research suggests that people can lower their risk of developing atherosclerosis by doing the following: regularly exercising, maintaining a healthful, balanced diet, maintaining a healthful bodyweight.

• #10 Treatment of Intestinal Ischemia – The University of Chicago MALS Program

  https://www.ucmals.com/treatment-of-intestinal-ischemia/

  With proper treatment and ongoing management, individuals with intestinal ischemia can lead healthy and fulfilling lives. […] It is important to note that early diagnosis and prompt treatment are crucial in improving the outcomes of intestinal ischemia. […] If you suspect you or someone you know may be experiencing symptoms of intestinal ischemia, it is important to seek medical attention immediately. […] Lifestyle changes may help manage intestinal ischemia. […] Quitting smoking is essential, as smoking can constrict blood vessels and worsen symptoms of intestinal ischemia. […] Regular exercise can help improve blood flow, strengthen the cardiovascular system, and reduce the risk of further blockages. […] It is important for individuals with chronic intestinal ischemia to work closely with their healthcare provider to determine the most appropriate treatment plan. […] The chosen treatment options may vary depending on the individual’s overall health, the severity of the condition, and the underlying cause of the ischemia.

• #11 How Ischemia Affects Different Parts of the Body

  https://www.verywellhealth.com/what-is-ischemia-p2-1745825

  Ischemia in the gastrointestinal tract is called intestinal ischemia or mesenteric ischemia. This type of ischemia occurs in the blood vessels supplying the intestinal organs. […] Chronic intestinal ischemia, which is usually produced by atherosclerosis of the intestinal arteries, typically causes recurrent symptoms after a meal, when the intestines are trying to perform their digestive work in the face of insufficient blood supply. Intestinal ischemia most often causes abdominal pain (referred to as intestinal angina) following a meal, especially a fatty meal. […] Acute intestinal ischemia may occur when an embolism (blood clot) lodges in the intestinal arteries. These blood clots most commonly originate in the heart, as a result of atrial fibrillation. If the embolism is severe enough, intestinal infarction (death of a portion of the intestine) can result. Intestinal infarction is a medical emergency.

• #12 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Severe abdominal pain out of proportion to physical examination findings should be assumed to be AMI until disproven. (Recommendation 1B) […] The key to early diagnosis is a high level of clinical suspicion. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. Electrolyte abnormalities should be corrected, and nasogastric decompression initiated. (Recommendation 1B) […] Broad-spectrum antibiotics should be administered immediately. Unless contraindicated, patients should be anticoagulated with intravenous unfractionated heparin. (Recommendation 1B) […] Prompt laparotomy should be done for patients with overt peritonitis. (Recommendation 1A) […] Damage control surgery is an important adjunct for patients who require intestinal resection due to the necessity to reassess bowel viability and in patients with refractory sepsis. Planned re-laparotomy is an essential part of AMI management. (Recommendation 1B)

• #13 Intestinal Ischemia | AMBOSS Rotation Prep

  https://resident360.amboss.com/adult-medicine/gastroenterology/intestinal-ischemia/intestinal-ischemia.html

  Intestinal ischemia can be broadly categorized as either mesenteric (small-bowel) ischemia or colonic ischemia and can present as acute or chronic disease. […] The cardinal sign of intestinal ischemia is abdominal pain. Although intestinal ischemia is largely considered a rare cause of abdominal pain, delayed diagnosis can be associated with significant morbidity and mortality. […] Immediate initiation of broad-spectrum antibiotics is recommended due to the high risk of infection associated with acute mesenteric ischemia. […] Anticoagulation with heparin infusion should also be initiated as soon as possible once a diagnosis is made. […] Patients who undergo revascularization are recommended to be placed on anticoagulation for at least 6 months or possibly lifelong if there is underlying hypercoagulability. […] Most cases resolve spontaneously and thus treatment is generally supportive, with aggressive hydration, bowel rest, and occasionally antibiotics in moderate or severe disease due to risk for infection.

• #14 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. (Recommendation 1B) […] When NOMI is suspected, the treatment focus should be to correct the underlying cause and to restore mesenteric perfusion. Infarcted bowel should be resected promptly. (Recommendation 1B) […] The finding of massive gut necrosis requires careful assessment of the patients underlying co-morbidities and advanced directives in order to judge whether comfort carries the best treatment. (Recommendation 1C)

• #15 Mesenteric Ischemia

  https://healthlibrary.inova.org/Search/134,203

  The best way to prevent this condition is to make healthy lifestyle choices: […] If you have had mesenteric ischemia in the past, your healthcare provider may suggest you take anticoagulation or antiplatelet medicines to prevent future attacks.

• #16 Medication for Mesenteric Ischemia | NYU Langone Health

  https://nyulangone.org/conditions/mesenteric-ischemia/treatments/medication-for-mesenteric-ischemia

  Medications can help manage blood clots and symptoms caused by a blockage, such as intestinal inflammation. […] Other times, they are used to prevent blood clots from forming after treatment. […] Anticoagulants, or blood thinners, are used to prevent blood clots from forming after surgery to treat mesenteric ischemia. […] Vasodilators relax the arteries, helping to prevent them from narrowing. This helps increase blood and oxygen flow to the intestines. […] Your doctor may prescribe antibiotics to prevent sepsis, a potentially life-threatening complication of an infection.

• #17 Prophylactic Treatment of Intestinal Ischemia-Reperfusion Injury Reduces Mucosal Damage and Improves Intestinal Absorption

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10518153/

  Intestinal ischemia-reperfusion injury (iIRI) involves a blood flow interruption in an intestinal segment followed by blood flow restoration. […] Our goal was to evaluate the potential of three antioxidant and/or antiinflammatory compounds (curcumin, dexmedetomidine and -tocopherol) to prevent or reverse local and systemic damage induced by iIRI. […] Only experimental studies have explored preventive treatment options for various ischemia reperfusion syndromes (IRI), both iIRI as well as liver, lower limb, kidney or even retina. […] In this context, plant-derived compounds have shown great potential in the clinical setting, not only in IRI therapies, but also for oncology or rheumatic disorders. […] Therefore, its focus lies only on prevention of ischemic injury, reduction of time to reperfusion as short as possible, and multiorgan failure, but does not address the treatment of reperfusion syndrome after restoration of blood flow. […] In our experimental model of i-IRI, prophylactic treatment with anti-inflammatory or antioxidant substances has allowed both a decrease in localized injury to the intestinal mucosa and a substantial improvement in intestinal absorption.

• #18 Prophylactic treatment of intestinal ischemia-reperfusion | JIR

  https://www.dovepress.com/prophylactic-treatment-of-intestinal-ischemia-reperfusion-injury-reduc-peer-reviewed-fulltext-article-JIR

  Intestinal ischemia-reperfusion injury (iIRI) involves a blood flow interruption in an intestinal segment followed by blood flow restoration. Our goal was to evaluate the potential of three antioxidant and/or antiinflammatory compounds (curcumin, dexmedetomidine and -tocopherol) to prevent or reverse local and systemic damage induced by iIRI. […] Only experimental studies have explored preventive treatment options for various ischemia reperfusion syndromes (IRI), both iIRI as well as liver, lower limb, kidney or even retina. In this context, plant-derived compounds have shown great potential in the clinical setting, not only in IRI therapies, but also for oncology or rheumatic disorders. […] In our experimental model of i-IRI, prophylactic treatment with anti-inflammatory or antioxidant substances has allowed both a decrease in localized injury to the intestinal mucosa and a substantial improvement in intestinal absorption. Finally, in terms of systemic effects, none of the treatments achieved a relevant reduction in hepatic damage, and only dexmedetomidine succeeded in reducing renal damage, as measured by urea and creatinine levels.

• #19 Ischemic Colitis: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/facts-about-ischemic-colitis

  Ischemic Colitis Prevention […] For most people, an ischemic colitis attack is a one-time thing — it never happens again. In others, it can become an ongoing problem. […] You might be able to prevent another episode. To stack the odds in your favor: Stay hydrated, to avoid constipation and blood vessel constriction. Discuss your medications with your doctor. If one medication triggered the problem, your doctor may know of others that will work better for you. Maintain normal blood pressure, but avoid aggressive treatments for high blood pressure. Stop smoking. It damages virtually all your organs, including blood vessels. […] If you have heart disease, your doctor may recommend blood thinners. More clinical studies are needed before this becomes a general recommendation for all heart disease patients with ischemic colitis. People who also develop mesenteric venous thrombosis may also be put on blood thinners. […] Systemic corticosteroids are not recommended to treat or prevent ischemic colitis. That’s because they may worsen damage and cause a perforation or tear in the colon. Ongoing studies are looking at whether certain IV steroids given with IV antibiotics can help in cases of severe ischemic colitis.

• #20

  https://journals.lww.com/ajg/fulltext/2011/10002/ischemic_bowel_in_a_post_cardiac_surgery_patient.686.aspx

  Purpose: Description of a case of mesenteric ischemia following treatment with octreotide. […] The reduction of splanchnic blood flow by octreotide may have precipitated mesenteric ischemia in this patient. We recommend that patients with underlying vascular disease be observed carefully when somatostatin or octreotide therapy is instituted.

• #21 What is bowel ischaemia? – Heart Matters magazine – BHF

  https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/bowel-ischaemia

  Ischaemic bowel is a rare circulatory condition which can be linked with other heart and circulatory diseases. […] You can reduce your risk by looking after your health, including taking regular exercise, stopping smoking and eating a healthy diet. High blood pressure, raised cholesterol and diabetes need treatment and monitoring. Medication to reduce the risk of clots may also be needed.

• #22 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  How can I prevent ischemic colitis? So many things can lead to ischemic colitis that it may not be possible to prevent all of them. However, its always a good idea to take care of your preexisting conditions, especially those that affect your heart, blood vessels and kidneys. Avoiding smoking or using recreational drugs and eating a heart-healthy diet may prevent these conditions from worsening or causing complications. Strenuous exercise can also lead to ischemic colitis (runners colitis) by stressing your hearts capacity to pump enough blood. If youre an endurance athlete, staying well-hydrated can help prevent this.

• #23 Intestinal Ischemia – Internal Medicine Residency Handbook

  https://vim-book.org/gastroenterology/gastroenterology-intestinal-ischemia/

  Chronic Mesenteric Ischemia […] Conservative management if asymptomatic: smoking cessation and secondary prevention to limit progression of atherosclerotic disease […] Revascularization (open vs. endovascular) is indicated if symptoms are present […] Mesenteric angioplasty and stenting is first-line therapy […] Goal is to prevent future bowel infarction.

• #24 Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery

  https://scholarworks.indianapolis.iu.edu/items/e7e81a21-8db9-4969-b5ed-a06917eb9b96

  Background: Chronic mesenteric ischemia (CMI) results from the inability to achieve adequate postprandial intestinal blood flow, usually from atherosclerotic occlusive disease at the origins of the mesenteric vessels. […] The treatment goals include relieving the presenting symptoms, preventing progression to acute mesenteric ischemia, and improving overall quality of life. […] Long-term follow-up and surveillance are recommended after revascularization and for asymptomatic patients with severe mesenteric occlusive disease. […] These practice guidelines were developed based on the best available evidence. They should help to optimize the care of patients with CMI.

• #25 The Dangerous Miss: Recognizing Acute Mesenteric Ischemia | Emergency Physicians Monthly

  https://epmonthly.com/article/the-dangerous-miss/

  The key to management is initiation of treatment while diagnostic evaluation is underway. Optimal treatment requires a multidisciplinary approach: general surgery, vascular surgery, and interventional radiology. Surgical intervention that can be initiated in less than six hours from symptom onset adds significant increase in survival. […] Aggressive fluid resuscitation, electrolyte management, and broad-spectrum antibiotics are needed early in the course. Avoid oral intake, which can exacerbate ischemia. Patients may require 10-20 L of IV fluids within the first 24 hours due to extensive capillary leakage and third spacing. Begin anticoagulation in consultation with the treating surgeon, usually with unfractionated heparin. […] Treatment requires surgery and interventional radiology consultation, IV antibiotics, IV fluids, and anticoagulation. Ultimately, the physician at the bedside is the best diagnostic tool.

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