Materiały źródłowe

• #1 Small Bowel Ischemia – American College of Gastroenterology

  https://gi.org/topics/small-bowel-ischemia/

  Small bowel ischemia (also called mesenteric ischemia) is a potentially life-threatening group of conditions that reduce blood flow to the small intestine (e.g., duodenum, jejunum or ileum). Symptoms can range from mild to severe depending on the cause. […] Early diagnosis and treatment are essential for the best possible outcomes to restore digestive function. […] Small bowel ischemia requires prompt medical care to avoid damage to intestinal tissue that can lead to death. […] Acute small bowel ischemia requires immediate medical attention. If left untreated, the lack of blood supply to the intestines can quickly damage intestinal tissue and lead to tissue death. […] The goals of treatment are to restore blood supply to the intestines and maintain proper function in the digestive tract. Treatment options for intestinal ischemia vary depending on the cause of the condition and the severity of damage in the intestines.

• #2 Mesenteric Ischemia I Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/heart-rhythm/mesenteric-ischemia

  Mesenteric ischemia prevents the intestines from receiving adequate oxygen to function properly. […] Mesenteric ischemia usually affects your small intestine, but can also impact other organs such as your stomach, colon or liver. […] At Ohio State, our vascular surgeons are experienced in diagnosing mesenteric ischemia, and in all forms of treatment for mesenteric ischemia, including minimally invasive angioplasty and stenting, and open surgical bypass for more complex cases. […] Mesenteric ischemia is a serious condition that can begin and progress quickly. The sooner you receive medical treatment, the better your outcome is likely to be. The goal of treatment is to restore adequate blood flow to your intestines through your mesenteric arteries. […] Angioplasty and stenting is a minimally invasive procedure where your surgeon inflates a small balloon inside of your narrowed artery, causing the artery to expand.

• #3 A CASE OF ACUTE MESENTERIC ISCHEMIA: A LIFE-THREATENING CATASTROPHE – SHM Abstracts | Society of Hospital Medicine

  https://shmabstracts.org/abstract/a-case-of-acute-mesenteric-ischemia-a-life-threatening-catastrophe/

  Acute Mesenteric Ischemia is a rare, life-threatening vascular emergency due to sudden reduction or cessation of intestinal blood flow with an overall mortality of 30% to 80%. […] The diagnosis is very challenging due to the lack of specific clinical signs, often leading to the diagnosis at an advanced stage. […] In the absence of specific diagnostic markers and clinical signs, early imaging is the key to promptly diagnosing AMI. […] This case demonstrates the importance of considering AMI in patients with a high level of clinical suspicion, even in the absence of known risk factors such as atrial fibrillation or a history of atherosclerotic disease, as a rapid diagnosis is essential to prevent mortality. […] Even though acute mesenteric ischemia is an uncommon disease, it is almost always life-threatening with mortality rates up to 50% despite treatment. Hence, cases with high clinical suspicion should be approached aggressively, as early and timely treatment can be potentially life-saving.

• #4

  https://link.springer.com/article/10.1007/s00134-024-07363-1

  Acute mesenteric ischaemia (AMI) is a condition where different etiopathogenetic pathways may lead to necrosis of the bowel and thereby to lethal outcome. […] AMI is diagnosed in 0.040.07% of adult hospital admissions, with a highly variable proportion (050%) of non-occlusive mesenteric ischaemia (NOMI) observed in different hospitals. […] Accordingly, it is imperative for intensivists to be aware of AMIespecially NOMIas this condition is often underrecognized and underdiagnosed, and the intensive care unit (ICU) team often plays a key role in diagnosing and managing AMI. […] The ultimate target of management of AMI is to restore perfusion of the bowel before irreversible bowel damage has occurred. […] Therefore, immediate revascularization in acute SMA occlusion should have priority in management.

• #5

  https://www.nursingcenter.com/journalarticle?Article_ID=7141976&Journal_ID=54016&Issue_ID=7141942

  Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. […] Chronic mesenteric ischemia can develop into acute mesenteric ischemia, which has high mortality. […] Acute mesenteric ischemia can be occlusive (caused by arterial embolism, arterial thrombosis, or mesenteric venous thrombosis) or nonocclusive, with treatment depending on the underlying cause.

• #6 Mesenteric Ischemia

  https://errolozdalga.com/medicine/pages/mesentericischemia.cr.5.16.11.html

  Mesenteric Ischemia can be divided into Acute vs Chronic, and Small Bowel vs Colonic Ischemia. […] Acute Mesenteric Ischemia can be further divided into Occlusive vs Non-occlusive etiologies. […] Clinical presentation is classically that of acute onset of severe periumbilical pain that is out of proportion to physical exam findings, +/- nausea/vomiting. […] It is important to note that in nonocclusive disease, ~25% of patients may have no abdominal pain. […] They have bad preexisting atherosclerosis, and often have a history of Intestinal Angina representing chronic mesenteric ischemia where they have postprandial pain, nausea/vomiting, early satiety, and weight loss. […] This occurs in patients with bad atherosclerotic disease who are hypotensive (i.e. sepsis, CHF, etc), often on pressors, or other meds that cause decreased intestinal blood flow or vasoconstriction (Digoxin, Cocaine, Diuretics).

• #7

  https://www.nursingcenter.com/journalarticle?Article_ID=7141976&Journal_ID=54016&Issue_ID=7141942

  Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. […] Chronic mesenteric ischemia can develop into acute mesenteric ischemia, which has high mortality. […] Acute mesenteric ischemia can be occlusive (caused by arterial embolism, arterial thrombosis, or mesenteric venous thrombosis) or nonocclusive, with treatment depending on the underlying cause.

• #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. […] Your doctor will insert a balloon-tipped catheter inside the blocked artery at the point of the blockage.

• #9

  https://journals.lww.com/gastroenterologynursing/fulltext/2018/07000/mesenteric_ischemia__concepts_of_care_for_the.3.aspx

  Bedside nurses require excellent observational and assessment skills. […] Mesenteric ischemia requires that nurses be aware of the different etiologies and presentations of this uncommon disease to alert physicians of changes in a patient’s condition and detect clues that may assist with an accurate and prompt diagnosis. […] Being educated about the diagnostic procedures, possible outcomes, and anticipated care and needs of patients affected by this medical complication is imperative to maintain the health status and well-being of these patients and their families.

• #10 Acute mesenteric ischemia

  https://www.myamericannurse.com/acute-mesenteric-ischemia/

  With a mortality rate exceeding 50%, acute mesenteric ischemia requires prompt nursing identification and vascular intervention. […] Most patients experience acute onset of abdominal pain out of proportion to a physical examination, nausea, vomiting, and melena. […] Prompt surgical evaluation is necessary to identify, minimize, and prevent irreversible intestinal damage. […] However, no specific laboratory studies indicate AMI. Initially, symptoms may be nonspecific, resulting in delayed diagnosis, so astute nursing assessments are critical. Prompt surgical evaluation identifies, minimizes, and prevents irreversible damage irreversible intestinal damage. […] Activation of the RRT facilitated a quick assessment and implementation of evidence-based treatment.

• #11

  https://journals.lww.com/gastroenterologynursing/fulltext/2018/07000/mesenteric_ischemia__concepts_of_care_for_the.3.aspx

  Bedside nurses require excellent observational and assessment skills. […] Mesenteric ischemia requires that nurses be aware of the different etiologies and presentations of this uncommon disease to alert physicians of changes in a patient’s condition and detect clues that may assist with an accurate and prompt diagnosis. […] Being educated about the diagnostic procedures, possible outcomes, and anticipated care and needs of patients affected by this medical complication is imperative to maintain the health status and well-being of these patients and their families.

• #12

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. […] Acute mesenteric ischemia can result from arterial embolism, arterial thrombosis, venous thrombosis, or nonocclusive disease. […] Early identification of risk factors, recognition of signs of ischemia on imaging, and treatment are needed to improve patient outcomes. […] It is essential that acute care NPs recognize the clinical presentation of mesenteric ischemia, the underlying pathophysiology, and treatment options to improve patient outcomes. […] NPs play a crucial role in assessment, diagnosis, commencement of supportive care, and initiation of appropriate consults. […] Patients whose clinical presentation is concerning for acute mesenteric ischemia need early initiation of supportive care.

• #13 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. Its severity depends on the vessels involved and whether collateral blood vessels are available to prevent malperfusion. Early recognition and treatment are imperative to improve patient outcomes. […] Diagnosis requires a high index of suspicion with focused evaluation. […] Early recognition and intervention are key to preventing morbidity and mortality. […] The nonspecific nature of symptoms makes it difficult to differentiate acute mesenteric ischemia from other intra-abdominal pathologies such as acute cholecystitis, pancreatitis, and small-bowel obstruction. A high index of suspicion is critical to making the diagnosis and restoring blood flow, thereby improving patient outcomes. […] Treatment is focused on hemodynamic support and correcting the underlying cause. Transcatheter infusion of vasodilators such as papaverine and nitroglycerin may be used to relieve mesenteric vasoconstriction in cases where bowel necrosis has not occurred, and laparotomy is indicated when acute peritoneal signs are present. […] Early recognition and focused evaluation are crucial for timely diagnosis and prevention of catastrophic complications.

• #14 Acute mesenteric ischemia

  https://www.myamericannurse.com/acute-mesenteric-ischemia/

  With a mortality rate exceeding 50%, acute mesenteric ischemia requires prompt nursing identification and vascular intervention. […] Most patients experience acute onset of abdominal pain out of proportion to a physical examination, nausea, vomiting, and melena. […] Prompt surgical evaluation is necessary to identify, minimize, and prevent irreversible intestinal damage. […] However, no specific laboratory studies indicate AMI. Initially, symptoms may be nonspecific, resulting in delayed diagnosis, so astute nursing assessments are critical. Prompt surgical evaluation identifies, minimizes, and prevents irreversible damage irreversible intestinal damage. […] Activation of the RRT facilitated a quick assessment and implementation of evidence-based treatment.

• #15

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. […] Acute mesenteric ischemia can result from arterial embolism, arterial thrombosis, venous thrombosis, or nonocclusive disease. […] Early identification of risk factors, recognition of signs of ischemia on imaging, and treatment are needed to improve patient outcomes. […] It is essential that acute care NPs recognize the clinical presentation of mesenteric ischemia, the underlying pathophysiology, and treatment options to improve patient outcomes. […] NPs play a crucial role in assessment, diagnosis, commencement of supportive care, and initiation of appropriate consults. […] Patients whose clinical presentation is concerning for acute mesenteric ischemia need early initiation of supportive care.

• #16 Acute mesenteric ischemia

  https://www.myamericannurse.com/acute-mesenteric-ischemia/

  With a mortality rate exceeding 50%, acute mesenteric ischemia requires prompt nursing identification and vascular intervention. […] Most patients experience acute onset of abdominal pain out of proportion to a physical examination, nausea, vomiting, and melena. […] Prompt surgical evaluation is necessary to identify, minimize, and prevent irreversible intestinal damage. […] However, no specific laboratory studies indicate AMI. Initially, symptoms may be nonspecific, resulting in delayed diagnosis, so astute nursing assessments are critical. Prompt surgical evaluation identifies, minimizes, and prevents irreversible damage irreversible intestinal damage. […] Activation of the RRT facilitated a quick assessment and implementation of evidence-based treatment.

• #17

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. […] Acute mesenteric ischemia can result from arterial embolism, arterial thrombosis, venous thrombosis, or nonocclusive disease. […] Early identification of risk factors, recognition of signs of ischemia on imaging, and treatment are needed to improve patient outcomes. […] It is essential that acute care NPs recognize the clinical presentation of mesenteric ischemia, the underlying pathophysiology, and treatment options to improve patient outcomes. […] NPs play a crucial role in assessment, diagnosis, commencement of supportive care, and initiation of appropriate consults. […] Patients whose clinical presentation is concerning for acute mesenteric ischemia need early initiation of supportive care.

• #18

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Regardless of the specific type, initial treatment should include volume resuscitation with crystalloids to improve perfusion and oxygenation; provision of supplemental oxygen; connection of the nasogastric tube to suction and N.P.O. status for bowel rest; correction of electrolyte abnormalities; and initiation of systemic anticoagulation, unless there are contraindications. […] For suspected acute mesenteric ischemia, regardless of occlusive versus nonocclusive process, NPs should obtain a CTA as previously outlined to confirm diagnosis and attempt to determine cause. […] The treatment process should be commenced according to the following guide based on the cause supported by CTA findings and depending on the presence of clinical signs of peritonitis. […] If acute mesenteric ischemia (regardless of type) is found on CTA and the patient has clinical signs of peritonitis, emergency laparotomy or laparoscopy is typically needed for resection of necrotic bowel. […] Anticoagulation has been shown to improve patient outcomes and is an essential part of treatment for acute mesenteric ischemia.

• #19 Acute mesenteric ischaemia in the acute hospital setting (Guidelines) | Right Decisions

  https://rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/vascular/acute-mesenteric-ischaemia-in-the-acute-hospital-setting-guidelines/

  Admit under the care of General Surgeon on call (Consultant of the Week during the day, Consultant of the Day out-of-hours) […] Alert Consultant as soon as suspicion of mesenteric ischaemia is raised […] Start supportive treatment immediately oxygen, fluid resuscitation, analgesia […] Give IV antibiotics if signs of perforation or sepsis from bacterial translocation […] Consider IV heparin infusion; anticoagulation is the mainstay of treatment for acute mesenteric venous thrombosis […] Consider level 2 care if significant physiological derangement present […] Keep patient nil-by-mouth […] Consultant-to-Consultant referral to Vascular Surgery is essential as soon as clinical or radiological working diagnosis is made […] Consultant Vascular Surgeon may discuss patient with Consultant in Interventional Radiology if endovascular approach is judged to be an option (depending on availability) […] Consultant General Surgeon is responsible for co-ordination of care and will remain in charge […] Patient care may be transferred to Consultant Vascular Surgeon if revascularisation is successful.

• #20

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Regardless of the specific type, initial treatment should include volume resuscitation with crystalloids to improve perfusion and oxygenation; provision of supplemental oxygen; connection of the nasogastric tube to suction and N.P.O. status for bowel rest; correction of electrolyte abnormalities; and initiation of systemic anticoagulation, unless there are contraindications. […] For suspected acute mesenteric ischemia, regardless of occlusive versus nonocclusive process, NPs should obtain a CTA as previously outlined to confirm diagnosis and attempt to determine cause. […] The treatment process should be commenced according to the following guide based on the cause supported by CTA findings and depending on the presence of clinical signs of peritonitis. […] If acute mesenteric ischemia (regardless of type) is found on CTA and the patient has clinical signs of peritonitis, emergency laparotomy or laparoscopy is typically needed for resection of necrotic bowel. […] Anticoagulation has been shown to improve patient outcomes and is an essential part of treatment for acute mesenteric ischemia.

• #21 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Although relatively uncommon, mesenteric ischemia is responsible for significant morbidity and mortality in affected individuals. […] The rapid mobilization of a multidisciplinary team consisting of vascular surgeons, general surgeons, intensivists, and radiologists is crucial to address the needs of this critically ill patient population. […] Initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Most importantly, anticoagulation should run continuously and not be paused for surgery. […] A multidisciplinary approach focused on resuscitation and expiated revascularization is critical to ensure optimal outcomes.

• #22 Mesenteric Ischemia | Nurse Key

  https://nursekey.com/mesenteric-ischemia/

  1. Identify the nursing implications relevant to mesenteric ischemia. […] […] 2. Patients are treated with medical therapy unless they present with physical signs or laboratory evidence of peritonitis that requires surgery. […] […] 3. Initial Management Includes: Conditions that decrease mesenteric perfusion are treated. […] […] 4. A Foley catheter and peripheral arterial line are placed to monitor intravascular volume and hemodynamic status. […] […] 5. Nasogastric tube is placed to decrease chances of aspiration and for gastric decompression. […] […] 6. Narcotics are not initially given because they can blunt the signs of peritonitis. […] […] 7. Cathartics are contraindicated because they can cause colonic perforation. […] […] 8. In patients with NOMI, vasodilators such as papaverine may be administered.

• #23 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Supportive management: Airway protection may be required (high risk of aspiration), Mechanical ventilation (increased work of breathing due to acidosis), Circulatory support (vasodilated shock state), Analgesia and anaesthesia (opiates may actually be preferred, as they „rest the gut” by paralysing its motility), Neuromuscular junction blockers may help organ perfusion by their effect on abdominal compartment pressure, Electrolyte correction (particularly correction of acid-base balance), Fluid resuscitation (extensive third-space losses are to be expected), Abdominal compartment pressure – serial measurements, Parenteral nutrition (the patient should remain fasted), Antibiotics of a broad spectrum, eg. piperacillin/tazobactam or meropenem. […] Like with everything in ICU, the prognosis of mesenteric ischaemia is mainly related to whatever else is going on.

• #24

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Regardless of the specific type, initial treatment should include volume resuscitation with crystalloids to improve perfusion and oxygenation; provision of supplemental oxygen; connection of the nasogastric tube to suction and N.P.O. status for bowel rest; correction of electrolyte abnormalities; and initiation of systemic anticoagulation, unless there are contraindications. […] For suspected acute mesenteric ischemia, regardless of occlusive versus nonocclusive process, NPs should obtain a CTA as previously outlined to confirm diagnosis and attempt to determine cause. […] The treatment process should be commenced according to the following guide based on the cause supported by CTA findings and depending on the presence of clinical signs of peritonitis. […] If acute mesenteric ischemia (regardless of type) is found on CTA and the patient has clinical signs of peritonitis, emergency laparotomy or laparoscopy is typically needed for resection of necrotic bowel. […] Anticoagulation has been shown to improve patient outcomes and is an essential part of treatment for acute mesenteric ischemia.

• #25

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. […] Acute mesenteric ischemia can result from arterial embolism, arterial thrombosis, venous thrombosis, or nonocclusive disease. […] Early identification of risk factors, recognition of signs of ischemia on imaging, and treatment are needed to improve patient outcomes. […] It is essential that acute care NPs recognize the clinical presentation of mesenteric ischemia, the underlying pathophysiology, and treatment options to improve patient outcomes. […] NPs play a crucial role in assessment, diagnosis, commencement of supportive care, and initiation of appropriate consults. […] Patients whose clinical presentation is concerning for acute mesenteric ischemia need early initiation of supportive care.

• #26

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Regardless of the specific type, initial treatment should include volume resuscitation with crystalloids to improve perfusion and oxygenation; provision of supplemental oxygen; connection of the nasogastric tube to suction and N.P.O. status for bowel rest; correction of electrolyte abnormalities; and initiation of systemic anticoagulation, unless there are contraindications. […] For suspected acute mesenteric ischemia, regardless of occlusive versus nonocclusive process, NPs should obtain a CTA as previously outlined to confirm diagnosis and attempt to determine cause. […] The treatment process should be commenced according to the following guide based on the cause supported by CTA findings and depending on the presence of clinical signs of peritonitis. […] If acute mesenteric ischemia (regardless of type) is found on CTA and the patient has clinical signs of peritonitis, emergency laparotomy or laparoscopy is typically needed for resection of necrotic bowel. […] Anticoagulation has been shown to improve patient outcomes and is an essential part of treatment for acute mesenteric ischemia.

• #27 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)

• #28 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Supportive management: Airway protection may be required (high risk of aspiration), Mechanical ventilation (increased work of breathing due to acidosis), Circulatory support (vasodilated shock state), Analgesia and anaesthesia (opiates may actually be preferred, as they „rest the gut” by paralysing its motility), Neuromuscular junction blockers may help organ perfusion by their effect on abdominal compartment pressure, Electrolyte correction (particularly correction of acid-base balance), Fluid resuscitation (extensive third-space losses are to be expected), Abdominal compartment pressure – serial measurements, Parenteral nutrition (the patient should remain fasted), Antibiotics of a broad spectrum, eg. piperacillin/tazobactam or meropenem. […] Like with everything in ICU, the prognosis of mesenteric ischaemia is mainly related to whatever else is going on.

• #29

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  Mesenteric ischemia is a time-sensitive disease process as delays in diagnosis will lead to increased morbidity and mortality, especially in elderly patients. The first and most important initial action is to consider mesenteric ischemia in the differential diagnosis of all elderly patients with abdominal pain. […] Other initial actions will include large bore intravenous access, fluid resuscitation, and telemetry monitoring. […] Early surgical consultation is highly recommended so that the surgeons can closely follow the patient, do serial abdominal examinations, review the CT imaging with radiology, and take the patient to the OR rapidly thus saving as much bowel as possible. […] Initial treatment in mesenteric ischemia must focus on stabilization and resuscitation. Two large bore IVs with crystalloid fluids are necessary in patients, especially those who are hypotensive. Continuous monitoring of vital signs is paramount. Broad spectrum antibiotics covering bowel flora, such as ceftriaxone and metronidazole, should be started.

• #30 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Most of the discussion will be about acute mesenteric ischaemia as it is seen more commonly in critical care environments, but chronic mesenteric ischaemia is also a thing – more akin to claudication of the gut – which will receive some minimum of attention here. […] Specific management: […] Occlusive mesenteric ischaemia: Endovascular repair, Open repair with or without vascular bypass, Catheter-directed clot aspiration or thrombolysis, Stenting of dissected segments. […] Non-occlusive mesenteric ischaemia: Management of the shock state which focuses on maximising splanchnic blood flow (eg. decreased doses of vasopressors, increased inodilators). […] Venous mesenteric ischaemia: Anticoagulation, Endovascular clot retrieval. […] In all cases, bowel resection of the infarcted bowel may be the only option.

• #31 Mesenteric Ischemia | Society for Vascular Surgery

  https://vascular.org/your-vascular-health/vascular-conditions/mesenteric-ischemia

  Mesenteric ischemia is poor circulation in the vessels supplying blood flow to your mesenteric organs: your stomach, liver, colon and intestine. With poor circulation, blockages can form and compromise the function of these organs. […] The goal of treatment for mesenteric ischemia (both chronic and acute) is to re-open the artery to allow adequate blood flow to your intestine so it will work properly. This must be accomplished before permanent damage is done. The specifics of your condition will guide your vascular surgeon on whether to recommend treatment on an emergency or elective (scheduled procedure) basis. […] In Acute Cases: Narcotic pain medications may be given to alleviate severe pain. Treatment is usually an emergency procedure since severe intestinal damage can occur rapidly. If a clot is found early, your vascular surgeon may recommend percutaneous thrombectomy or thrombolytic therapy. This treatment involves sucking out the clot from within the artery or injecting clot-dissolving medication into the blood vessel. It is often given at the same time as a diagnostic angiogram. If there is evidence of intestinal damage or too little time is available for percutaneous treatment or for the thrombolytic agent to work, open surgery may be needed to remove the clot and restore blood flow to your intestinal arteries. Some patients require surgery to remove damaged portions of the intestine. This is a decision your vascular surgeon will make, often in conjunction with other surgical specialists.

• #32 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Most of the discussion will be about acute mesenteric ischaemia as it is seen more commonly in critical care environments, but chronic mesenteric ischaemia is also a thing – more akin to claudication of the gut – which will receive some minimum of attention here. […] Specific management: […] Occlusive mesenteric ischaemia: Endovascular repair, Open repair with or without vascular bypass, Catheter-directed clot aspiration or thrombolysis, Stenting of dissected segments. […] Non-occlusive mesenteric ischaemia: Management of the shock state which focuses on maximising splanchnic blood flow (eg. decreased doses of vasopressors, increased inodilators). […] Venous mesenteric ischaemia: Anticoagulation, Endovascular clot retrieval. […] In all cases, bowel resection of the infarcted bowel may be the only option.

• #33 Mesenteric ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mesenteric-ischemia/diagnosis-treatment/drc-20450391

  Our caring team of Mayo Clinic experts can help you with your mesenteric ischemia-related health concerns […] If a blood clot causes a sudden loss of blood flow to the small intestine, you might require immediate surgery to treat your mesenteric ischemia. […] Mesenteric ischemia that develops over time might be treated with angioplasty. Angioplasty is a procedure that uses a balloon to open the narrowed area. A mesh tube called a stent might be placed in the narrowed area. […] Mesenteric ischemia also can be treated via open surgery through an incision.

• #34

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  The ultimate management of acute mesenteric ischemia is challenging, ever-changing and diverse. Treatment can range from non-operative management with medications, intravascular thrombolytics, percutaneous angioplasty, operative revascularization, resection of bowel, or a combination of therapies. […] The treatment of choice for mesenteric artery embolus is embolectomy and bowel visualization to assess for signs of necrosis. […] In this etiology, heparin should be started as soon as the diagnosis is made and prior to surgery. […] If there are signs of infarction, then operative care is required. Otherwise thrombectomy with endarterectomy or distal bypass is the first choice of treatment. […] The treatment is to diagnose the underlying cause of the low flow state to the bowel such as sepsis or decreased cardiac output. Patients who develop peritoneal signs must go to the OR.

• #35

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  The ultimate management of acute mesenteric ischemia is challenging, ever-changing and diverse. Treatment can range from non-operative management with medications, intravascular thrombolytics, percutaneous angioplasty, operative revascularization, resection of bowel, or a combination of therapies. […] The treatment of choice for mesenteric artery embolus is embolectomy and bowel visualization to assess for signs of necrosis. […] In this etiology, heparin should be started as soon as the diagnosis is made and prior to surgery. […] If there are signs of infarction, then operative care is required. Otherwise thrombectomy with endarterectomy or distal bypass is the first choice of treatment. […] The treatment is to diagnose the underlying cause of the low flow state to the bowel such as sepsis or decreased cardiac output. Patients who develop peritoneal signs must go to the OR.

• #36 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Although relatively uncommon, mesenteric ischemia is responsible for significant morbidity and mortality in affected individuals. […] The rapid mobilization of a multidisciplinary team consisting of vascular surgeons, general surgeons, intensivists, and radiologists is crucial to address the needs of this critically ill patient population. […] Initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Most importantly, anticoagulation should run continuously and not be paused for surgery. […] A multidisciplinary approach focused on resuscitation and expiated revascularization is critical to ensure optimal outcomes.

• #37 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Most of the discussion will be about acute mesenteric ischaemia as it is seen more commonly in critical care environments, but chronic mesenteric ischaemia is also a thing – more akin to claudication of the gut – which will receive some minimum of attention here. […] Specific management: […] Occlusive mesenteric ischaemia: Endovascular repair, Open repair with or without vascular bypass, Catheter-directed clot aspiration or thrombolysis, Stenting of dissected segments. […] Non-occlusive mesenteric ischaemia: Management of the shock state which focuses on maximising splanchnic blood flow (eg. decreased doses of vasopressors, increased inodilators). […] Venous mesenteric ischaemia: Anticoagulation, Endovascular clot retrieval. […] In all cases, bowel resection of the infarcted bowel may be the only option.

• #38 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access. […] Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #39 Mesenteric Ischemia | Nurse Key

  https://nursekey.com/mesenteric-ischemia/

  1. Identify the nursing implications relevant to mesenteric ischemia. […] […] 2. Patients are treated with medical therapy unless they present with physical signs or laboratory evidence of peritonitis that requires surgery. […] […] 3. Initial Management Includes: Conditions that decrease mesenteric perfusion are treated. […] […] 4. A Foley catheter and peripheral arterial line are placed to monitor intravascular volume and hemodynamic status. […] […] 5. Nasogastric tube is placed to decrease chances of aspiration and for gastric decompression. […] […] 6. Narcotics are not initially given because they can blunt the signs of peritonitis. […] […] 7. Cathartics are contraindicated because they can cause colonic perforation. […] […] 8. In patients with NOMI, vasodilators such as papaverine may be administered.

• #40 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access. […] Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #41 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access. […] Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #42 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)

• #43 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access. […] Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #44 Mesenteric Ischemia Treatment – San Diego – Scripps Health

  https://www.scripps.org/services/vascular-disease-care/mesenteric-ischemia-and-thrombosis-treatment

  Trans-aortic endarterectomy is a surgical procedure in which plaque is removed from a mesenteric artery, so it is no longer narrowed or blocked. […] Arterial bypass surgery allows a vascular surgeon to create a detour around the narrowed or blocked portion of a mesenteric artery. […] Thrombolysis is used to dissolve a blood clot by injecting clot-busting medication directly into the blocked mesenteric vein.

• #45 Acute Mesenteric Ischaemia – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/vascular/peripheral/mesenteric-ischaemia/

  Post-operatively the patient should be on the intensive care unit, planned for potential relook laparotomy in 24-48 hours; the majority of patients will end up with either covering loop or end stoma and there is a high chance of short gut syndrome. […] Revascularisation of the bowel, involving removal of any thrombus or embolism via radiological intervention, either suction thrombectomy or thrombolysis; the decision for revascularisation is made depending upon the state of the patient, the bowel, and the angiographic appearance of the mesenteric vessels. […] Venous ischaemia is typically managed in the same manner, however anticoagulation and bowel resection where required are the mainstay of management.

• #46 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Supportive management: Airway protection may be required (high risk of aspiration), Mechanical ventilation (increased work of breathing due to acidosis), Circulatory support (vasodilated shock state), Analgesia and anaesthesia (opiates may actually be preferred, as they „rest the gut” by paralysing its motility), Neuromuscular junction blockers may help organ perfusion by their effect on abdominal compartment pressure, Electrolyte correction (particularly correction of acid-base balance), Fluid resuscitation (extensive third-space losses are to be expected), Abdominal compartment pressure – serial measurements, Parenteral nutrition (the patient should remain fasted), Antibiotics of a broad spectrum, eg. piperacillin/tazobactam or meropenem. […] Like with everything in ICU, the prognosis of mesenteric ischaemia is mainly related to whatever else is going on.

• #47 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Supportive management: Airway protection may be required (high risk of aspiration), Mechanical ventilation (increased work of breathing due to acidosis), Circulatory support (vasodilated shock state), Analgesia and anaesthesia (opiates may actually be preferred, as they „rest the gut” by paralysing its motility), Neuromuscular junction blockers may help organ perfusion by their effect on abdominal compartment pressure, Electrolyte correction (particularly correction of acid-base balance), Fluid resuscitation (extensive third-space losses are to be expected), Abdominal compartment pressure – serial measurements, Parenteral nutrition (the patient should remain fasted), Antibiotics of a broad spectrum, eg. piperacillin/tazobactam or meropenem. […] Like with everything in ICU, the prognosis of mesenteric ischaemia is mainly related to whatever else is going on.

• #48 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Supportive management: Airway protection may be required (high risk of aspiration), Mechanical ventilation (increased work of breathing due to acidosis), Circulatory support (vasodilated shock state), Analgesia and anaesthesia (opiates may actually be preferred, as they „rest the gut” by paralysing its motility), Neuromuscular junction blockers may help organ perfusion by their effect on abdominal compartment pressure, Electrolyte correction (particularly correction of acid-base balance), Fluid resuscitation (extensive third-space losses are to be expected), Abdominal compartment pressure – serial measurements, Parenteral nutrition (the patient should remain fasted), Antibiotics of a broad spectrum, eg. piperacillin/tazobactam or meropenem. […] Like with everything in ICU, the prognosis of mesenteric ischaemia is mainly related to whatever else is going on.

• #49 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Although relatively uncommon, mesenteric ischemia is responsible for significant morbidity and mortality in affected individuals. […] The rapid mobilization of a multidisciplinary team consisting of vascular surgeons, general surgeons, intensivists, and radiologists is crucial to address the needs of this critically ill patient population. […] Initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Most importantly, anticoagulation should run continuously and not be paused for surgery. […] A multidisciplinary approach focused on resuscitation and expiated revascularization is critical to ensure optimal outcomes.

• #50 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Supportive management: Airway protection may be required (high risk of aspiration), Mechanical ventilation (increased work of breathing due to acidosis), Circulatory support (vasodilated shock state), Analgesia and anaesthesia (opiates may actually be preferred, as they „rest the gut” by paralysing its motility), Neuromuscular junction blockers may help organ perfusion by their effect on abdominal compartment pressure, Electrolyte correction (particularly correction of acid-base balance), Fluid resuscitation (extensive third-space losses are to be expected), Abdominal compartment pressure – serial measurements, Parenteral nutrition (the patient should remain fasted), Antibiotics of a broad spectrum, eg. piperacillin/tazobactam or meropenem. […] Like with everything in ICU, the prognosis of mesenteric ischaemia is mainly related to whatever else is going on.

• #51

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  Mesenteric ischemia is a time-sensitive disease process as delays in diagnosis will lead to increased morbidity and mortality, especially in elderly patients. The first and most important initial action is to consider mesenteric ischemia in the differential diagnosis of all elderly patients with abdominal pain. […] Other initial actions will include large bore intravenous access, fluid resuscitation, and telemetry monitoring. […] Early surgical consultation is highly recommended so that the surgeons can closely follow the patient, do serial abdominal examinations, review the CT imaging with radiology, and take the patient to the OR rapidly thus saving as much bowel as possible. […] Initial treatment in mesenteric ischemia must focus on stabilization and resuscitation. Two large bore IVs with crystalloid fluids are necessary in patients, especially those who are hypotensive. Continuous monitoring of vital signs is paramount. Broad spectrum antibiotics covering bowel flora, such as ceftriaxone and metronidazole, should be started.

• #52 Acute Mesenteric Ischaemia – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/vascular/peripheral/mesenteric-ischaemia/

  Post-operatively the patient should be on the intensive care unit, planned for potential relook laparotomy in 24-48 hours; the majority of patients will end up with either covering loop or end stoma and there is a high chance of short gut syndrome. […] Revascularisation of the bowel, involving removal of any thrombus or embolism via radiological intervention, either suction thrombectomy or thrombolysis; the decision for revascularisation is made depending upon the state of the patient, the bowel, and the angiographic appearance of the mesenteric vessels. […] Venous ischaemia is typically managed in the same manner, however anticoagulation and bowel resection where required are the mainstay of management.

• #53 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)

• #54 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Supportive management: Airway protection may be required (high risk of aspiration), Mechanical ventilation (increased work of breathing due to acidosis), Circulatory support (vasodilated shock state), Analgesia and anaesthesia (opiates may actually be preferred, as they „rest the gut” by paralysing its motility), Neuromuscular junction blockers may help organ perfusion by their effect on abdominal compartment pressure, Electrolyte correction (particularly correction of acid-base balance), Fluid resuscitation (extensive third-space losses are to be expected), Abdominal compartment pressure – serial measurements, Parenteral nutrition (the patient should remain fasted), Antibiotics of a broad spectrum, eg. piperacillin/tazobactam or meropenem. […] Like with everything in ICU, the prognosis of mesenteric ischaemia is mainly related to whatever else is going on.

• #55 Acute Mesenteric Ischaemia – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/vascular/peripheral/mesenteric-ischaemia/

  Post-operatively the patient should be on the intensive care unit, planned for potential relook laparotomy in 24-48 hours; the majority of patients will end up with either covering loop or end stoma and there is a high chance of short gut syndrome. […] Revascularisation of the bowel, involving removal of any thrombus or embolism via radiological intervention, either suction thrombectomy or thrombolysis; the decision for revascularisation is made depending upon the state of the patient, the bowel, and the angiographic appearance of the mesenteric vessels. […] Venous ischaemia is typically managed in the same manner, however anticoagulation and bowel resection where required are the mainstay of management.

• #56 Acute Mesenteric Ischaemia – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/vascular/peripheral/mesenteric-ischaemia/

  Post-operatively the patient should be on the intensive care unit, planned for potential relook laparotomy in 24-48 hours; the majority of patients will end up with either covering loop or end stoma and there is a high chance of short gut syndrome. […] Revascularisation of the bowel, involving removal of any thrombus or embolism via radiological intervention, either suction thrombectomy or thrombolysis; the decision for revascularisation is made depending upon the state of the patient, the bowel, and the angiographic appearance of the mesenteric vessels. […] Venous ischaemia is typically managed in the same manner, however anticoagulation and bowel resection where required are the mainstay of management.

• #57

  https://www.aast.org/didactic-curriculum-detail/acute-mesenteric-ischemia

  The fellow should be able to: […] Demonstrate an understanding of the evaluation and etiology of mesenteric ischemia […] Demonstrate an understanding of the treatment approach as related to the etiology of mesenteric ischemia […] Describe the options to restore perfusion in thrombotic and embolic mesenteric ischemia […] Describe the role of endovascular techniques in the management of mesenteric ischemia […] Describe options for the treatment of venous mesenteric ischemia […] Understand the potential for short-gut syndrome and how to manage this complication.

• #58 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access. […] Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #59 Acute and Chronic Mesenteric Ischemia | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/mesenteric-ischemia

  Mesenteric ischemia restricts blood flow to the small intestine and in some cases can be life-threatening. […] If you’re experiencing acute mesenteric ischemia, you may require emergency surgery to remove the blockage and restore blood flow to your intestine. Acute mesenteric ischemia can lead to sepsis and permanent intestinal damage and is a life-threatening condition. […] It’s important to also promptly seek treatment for chronic mesenteric ischemia, since failing to treat this condition can lead to serious issues such as malnutrition and severe weight loss. Chronic mesenteric ischemia can also progress into acute mesenteric ischemia. […] The specialists at Tampa General Hospital use a number of different methods to treat chronic mesenteric ischemia, including: prescribing medication such as anticoagulant or clot-busting medication, recommending lifestyle changes such as reducing fat intake, eating smaller meals on a more frequent basis, regularly exercising and properly managing any underlying conditions, performing surgery.

• #60 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. […] Your doctor will insert a balloon-tipped catheter inside the blocked artery at the point of the blockage.

• #61 Mesenteric Ischemia

  https://errolozdalga.com/medicine/pages/mesentericischemia.cr.5.16.11.html

  Mesenteric Ischemia can be divided into Acute vs Chronic, and Small Bowel vs Colonic Ischemia. […] Acute Mesenteric Ischemia can be further divided into Occlusive vs Non-occlusive etiologies. […] Clinical presentation is classically that of acute onset of severe periumbilical pain that is out of proportion to physical exam findings, +/- nausea/vomiting. […] It is important to note that in nonocclusive disease, ~25% of patients may have no abdominal pain. […] They have bad preexisting atherosclerosis, and often have a history of Intestinal Angina representing chronic mesenteric ischemia where they have postprandial pain, nausea/vomiting, early satiety, and weight loss. […] This occurs in patients with bad atherosclerotic disease who are hypotensive (i.e. sepsis, CHF, etc), often on pressors, or other meds that cause decreased intestinal blood flow or vasoconstriction (Digoxin, Cocaine, Diuretics).

• #62 Mesenteric Ischemia Treatment – San Diego – Scripps Health

  https://www.scripps.org/services/vascular-disease-care/mesenteric-ischemia-and-thrombosis-treatment

  Chronic mesenteric ischemia occurs when one or more of the mesenteric arteries is narrowed or blocked, depriving the intestines of oxygen. […] Acute mesenteric ischemia is a sudden blockage of one or more of the mesenteric arteries, which prevents blood and oxygen from reaching the intestines. […] Mesenteric venous thrombosis occurs when a blood clot blocks one of the mesenteric veins that carry blood away from the intestine. […] Scripps physicians can diagnose mesenteric disease using one or more of the following tests: […] Our vascular surgeons perform the following open surgical and endovascular approaches for treating mesenteric vascular disease. […] Angioplasty and stenting is an endovascular procedure that uses a balloon-tipped catheter to first inflate a narrowed mesenteric artery or vein, and then place a tiny mesh cylinder called a stent to keep the blood vessel permanently propped open.

• #63 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. […] Your doctor will insert a balloon-tipped catheter inside the blocked artery at the point of the blockage.

• #64 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. […] Your doctor will insert a balloon-tipped catheter inside the blocked artery at the point of the blockage.

• #65 Acute and Chronic Mesenteric Ischemia | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/mesenteric-ischemia

  Mesenteric ischemia restricts blood flow to the small intestine and in some cases can be life-threatening. […] If you’re experiencing acute mesenteric ischemia, you may require emergency surgery to remove the blockage and restore blood flow to your intestine. Acute mesenteric ischemia can lead to sepsis and permanent intestinal damage and is a life-threatening condition. […] It’s important to also promptly seek treatment for chronic mesenteric ischemia, since failing to treat this condition can lead to serious issues such as malnutrition and severe weight loss. Chronic mesenteric ischemia can also progress into acute mesenteric ischemia. […] The specialists at Tampa General Hospital use a number of different methods to treat chronic mesenteric ischemia, including: prescribing medication such as anticoagulant or clot-busting medication, recommending lifestyle changes such as reducing fat intake, eating smaller meals on a more frequent basis, regularly exercising and properly managing any underlying conditions, performing surgery.

• #66 Mesenteric Ischemia I Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/heart-rhythm/mesenteric-ischemia

  Mesenteric ischemia prevents the intestines from receiving adequate oxygen to function properly. […] Mesenteric ischemia usually affects your small intestine, but can also impact other organs such as your stomach, colon or liver. […] At Ohio State, our vascular surgeons are experienced in diagnosing mesenteric ischemia, and in all forms of treatment for mesenteric ischemia, including minimally invasive angioplasty and stenting, and open surgical bypass for more complex cases. […] Mesenteric ischemia is a serious condition that can begin and progress quickly. The sooner you receive medical treatment, the better your outcome is likely to be. The goal of treatment is to restore adequate blood flow to your intestines through your mesenteric arteries. […] Angioplasty and stenting is a minimally invasive procedure where your surgeon inflates a small balloon inside of your narrowed artery, causing the artery to expand.

• #67 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. […] Your doctor will insert a balloon-tipped catheter inside the blocked artery at the point of the blockage.

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

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

  Once the catheter is in place, your doctor will inflate and deflate the balloon. […] To make sure the artery stays open, your doctor may place a stent. […] An option when angioplasty is ineffective or when more than one blood vessel is blocked. […] Increases blood flow from the aorta to the blood vessels, supplying the bowel beyond the areas of narrowing. […] Your vascular surgeon uses a blood vessel from another location to create a detour around the blockage by attaching one end to the blocked artery above the blockage and the other end below the blockage. […] Symptoms typically improve immediately and you will receive close follow-up care through regular ultrasounds. […] 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).

• #69 Mesenteric Ischemia Treatment – San Diego – Scripps Health

  https://www.scripps.org/services/vascular-disease-care/mesenteric-ischemia-and-thrombosis-treatment

  Trans-aortic endarterectomy is a surgical procedure in which plaque is removed from a mesenteric artery, so it is no longer narrowed or blocked. […] Arterial bypass surgery allows a vascular surgeon to create a detour around the narrowed or blocked portion of a mesenteric artery. […] Thrombolysis is used to dissolve a blood clot by injecting clot-busting medication directly into the blocked mesenteric vein.

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

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

  Once the catheter is in place, your doctor will inflate and deflate the balloon. […] To make sure the artery stays open, your doctor may place a stent. […] An option when angioplasty is ineffective or when more than one blood vessel is blocked. […] Increases blood flow from the aorta to the blood vessels, supplying the bowel beyond the areas of narrowing. […] Your vascular surgeon uses a blood vessel from another location to create a detour around the blockage by attaching one end to the blocked artery above the blockage and the other end below the blockage. […] Symptoms typically improve immediately and you will receive close follow-up care through regular ultrasounds. […] 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).

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

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

  Once the catheter is in place, your doctor will inflate and deflate the balloon. […] To make sure the artery stays open, your doctor may place a stent. […] An option when angioplasty is ineffective or when more than one blood vessel is blocked. […] Increases blood flow from the aorta to the blood vessels, supplying the bowel beyond the areas of narrowing. […] Your vascular surgeon uses a blood vessel from another location to create a detour around the blockage by attaching one end to the blocked artery above the blockage and the other end below the blockage. […] Symptoms typically improve immediately and you will receive close follow-up care through regular ultrasounds. […] 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).

• #72 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access. […] Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #73 Mesenteric ischemia: Types, symptoms, and more

  https://www.medicalnewstoday.com/articles/mesenteric-ischemia

  For chronic mesenteric ischemia, a doctor may recommend: quitting smoking, if appropriate, taking antiplatelet medication to lower the risk of a blood clot, surgery to implant a stent or establish a bypass, dietary changes, if necessary. […] Mesenteric ischemia needs medical attention and can be a medical emergency. […] A person needs medical help if they experience new pain, bloating, or blood in the stool. […] The outlook for mesenteric ischemia will depend on various factors, such as whether it is acute or chronic, the cause, and how soon a person receives medical care. […] Seeking help as soon as symptoms arise can improve the outlook. […] It is important for anyone experiencing severe or sudden intestinal symptoms to seek emergency medical help.

• #74

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  Mesenteric ischemia is a time-sensitive disease process as delays in diagnosis will lead to increased morbidity and mortality, especially in elderly patients. The first and most important initial action is to consider mesenteric ischemia in the differential diagnosis of all elderly patients with abdominal pain. […] Other initial actions will include large bore intravenous access, fluid resuscitation, and telemetry monitoring. […] Early surgical consultation is highly recommended so that the surgeons can closely follow the patient, do serial abdominal examinations, review the CT imaging with radiology, and take the patient to the OR rapidly thus saving as much bowel as possible. […] Initial treatment in mesenteric ischemia must focus on stabilization and resuscitation. Two large bore IVs with crystalloid fluids are necessary in patients, especially those who are hypotensive. Continuous monitoring of vital signs is paramount. Broad spectrum antibiotics covering bowel flora, such as ceftriaxone and metronidazole, should be started.

• #75 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. Its severity depends on the vessels involved and whether collateral blood vessels are available to prevent malperfusion. Early recognition and treatment are imperative to improve patient outcomes. […] Diagnosis requires a high index of suspicion with focused evaluation. […] Early recognition and intervention are key to preventing morbidity and mortality. […] The nonspecific nature of symptoms makes it difficult to differentiate acute mesenteric ischemia from other intra-abdominal pathologies such as acute cholecystitis, pancreatitis, and small-bowel obstruction. A high index of suspicion is critical to making the diagnosis and restoring blood flow, thereby improving patient outcomes. […] Treatment is focused on hemodynamic support and correcting the underlying cause. Transcatheter infusion of vasodilators such as papaverine and nitroglycerin may be used to relieve mesenteric vasoconstriction in cases where bowel necrosis has not occurred, and laparotomy is indicated when acute peritoneal signs are present. […] Early recognition and focused evaluation are crucial for timely diagnosis and prevention of catastrophic complications.

• #76 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. Its severity depends on the vessels involved and whether collateral blood vessels are available to prevent malperfusion. Early recognition and treatment are imperative to improve patient outcomes. […] Diagnosis requires a high index of suspicion with focused evaluation. […] Early recognition and intervention are key to preventing morbidity and mortality. […] The nonspecific nature of symptoms makes it difficult to differentiate acute mesenteric ischemia from other intra-abdominal pathologies such as acute cholecystitis, pancreatitis, and small-bowel obstruction. A high index of suspicion is critical to making the diagnosis and restoring blood flow, thereby improving patient outcomes. […] Treatment is focused on hemodynamic support and correcting the underlying cause. Transcatheter infusion of vasodilators such as papaverine and nitroglycerin may be used to relieve mesenteric vasoconstriction in cases where bowel necrosis has not occurred, and laparotomy is indicated when acute peritoneal signs are present. […] Early recognition and focused evaluation are crucial for timely diagnosis and prevention of catastrophic complications.

• #77 Small Bowel Ischemia – American College of Gastroenterology

  https://gi.org/topics/small-bowel-ischemia/

  If you have small bowel ischemia but no damage to intestinal tissue, medications may be enough to manage the condition. […] Depending on your specific case, surgery might be the best treatment option. Typical surgical procedures include: Laparoscopy and Laparotomy. […] Small bowel ischemia can lead to complications such as: Rupture, Peritonitis, Scarring or narrowing of your colon, Tissue death. […] Early diagnosis and prompt treatment are essential to improve your chances for a good-outcome. The longer you go without treatment, the higher the chance of irreversible damage to the small bowel and, in an acute case, death.

• #78 Acute Mesenteric Ischaemia – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/vascular/peripheral/mesenteric-ischaemia/

  Post-operatively the patient should be on the intensive care unit, planned for potential relook laparotomy in 24-48 hours; the majority of patients will end up with either covering loop or end stoma and there is a high chance of short gut syndrome. […] Revascularisation of the bowel, involving removal of any thrombus or embolism via radiological intervention, either suction thrombectomy or thrombolysis; the decision for revascularisation is made depending upon the state of the patient, the bowel, and the angiographic appearance of the mesenteric vessels. […] Venous ischaemia is typically managed in the same manner, however anticoagulation and bowel resection where required are the mainstay of management.

• #79 Acute mesenteric ischemia

  https://www.myamericannurse.com/acute-mesenteric-ischemia/

  With a mortality rate exceeding 50%, acute mesenteric ischemia requires prompt nursing identification and vascular intervention. […] Most patients experience acute onset of abdominal pain out of proportion to a physical examination, nausea, vomiting, and melena. […] Prompt surgical evaluation is necessary to identify, minimize, and prevent irreversible intestinal damage. […] However, no specific laboratory studies indicate AMI. Initially, symptoms may be nonspecific, resulting in delayed diagnosis, so astute nursing assessments are critical. Prompt surgical evaluation identifies, minimizes, and prevents irreversible damage irreversible intestinal damage. […] Activation of the RRT facilitated a quick assessment and implementation of evidence-based treatment.

• #80 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)

• #81

  https://journals.lww.com/gastroenterologynursing/fulltext/2018/07000/mesenteric_ischemia__concepts_of_care_for_the.3.aspx

  Bedside nurses require excellent observational and assessment skills. […] Mesenteric ischemia requires that nurses be aware of the different etiologies and presentations of this uncommon disease to alert physicians of changes in a patient’s condition and detect clues that may assist with an accurate and prompt diagnosis. […] Being educated about the diagnostic procedures, possible outcomes, and anticipated care and needs of patients affected by this medical complication is imperative to maintain the health status and well-being of these patients and their families.

• #82

  https://link.springer.com/article/10.1007/s00134-024-07363-1

  Acute mesenteric ischaemia (AMI) is a condition where different etiopathogenetic pathways may lead to necrosis of the bowel and thereby to lethal outcome. […] AMI is diagnosed in 0.040.07% of adult hospital admissions, with a highly variable proportion (050%) of non-occlusive mesenteric ischaemia (NOMI) observed in different hospitals. […] Accordingly, it is imperative for intensivists to be aware of AMIespecially NOMIas this condition is often underrecognized and underdiagnosed, and the intensive care unit (ICU) team often plays a key role in diagnosing and managing AMI. […] The ultimate target of management of AMI is to restore perfusion of the bowel before irreversible bowel damage has occurred. […] Therefore, immediate revascularization in acute SMA occlusion should have priority in management.

• #83

  https://link.springer.com/article/10.1007/s00134-024-07363-1

  However, most patients receiving active treatment survive beyond their hospitalization. […] Identifying cases in which active intervention should be denied due to lack of efficacy remains to be clarified. […] A key to improve management of AMI is awareness, allowing adequately raised and communicated suspicion followed by early diagnosis and treatment.

• #84 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Although relatively uncommon, mesenteric ischemia is responsible for significant morbidity and mortality in affected individuals. […] The rapid mobilization of a multidisciplinary team consisting of vascular surgeons, general surgeons, intensivists, and radiologists is crucial to address the needs of this critically ill patient population. […] Initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Most importantly, anticoagulation should run continuously and not be paused for surgery. […] A multidisciplinary approach focused on resuscitation and expiated revascularization is critical to ensure optimal outcomes.

• #85

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  Mesenteric ischemia is a time-sensitive disease process as delays in diagnosis will lead to increased morbidity and mortality, especially in elderly patients. The first and most important initial action is to consider mesenteric ischemia in the differential diagnosis of all elderly patients with abdominal pain. […] Other initial actions will include large bore intravenous access, fluid resuscitation, and telemetry monitoring. […] Early surgical consultation is highly recommended so that the surgeons can closely follow the patient, do serial abdominal examinations, review the CT imaging with radiology, and take the patient to the OR rapidly thus saving as much bowel as possible. […] Initial treatment in mesenteric ischemia must focus on stabilization and resuscitation. Two large bore IVs with crystalloid fluids are necessary in patients, especially those who are hypotensive. Continuous monitoring of vital signs is paramount. Broad spectrum antibiotics covering bowel flora, such as ceftriaxone and metronidazole, should be started.

• #86 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Although relatively uncommon, mesenteric ischemia is responsible for significant morbidity and mortality in affected individuals. […] The rapid mobilization of a multidisciplinary team consisting of vascular surgeons, general surgeons, intensivists, and radiologists is crucial to address the needs of this critically ill patient population. […] Initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Most importantly, anticoagulation should run continuously and not be paused for surgery. […] A multidisciplinary approach focused on resuscitation and expiated revascularization is critical to ensure optimal outcomes.

• #87

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Mesenteric ischemia is a group of disorders requiring prompt identification, supportive care, and treatment. […] Acute mesenteric ischemia can result from arterial embolism, arterial thrombosis, venous thrombosis, or nonocclusive disease. […] Early identification of risk factors, recognition of signs of ischemia on imaging, and treatment are needed to improve patient outcomes. […] It is essential that acute care NPs recognize the clinical presentation of mesenteric ischemia, the underlying pathophysiology, and treatment options to improve patient outcomes. […] NPs play a crucial role in assessment, diagnosis, commencement of supportive care, and initiation of appropriate consults. […] Patients whose clinical presentation is concerning for acute mesenteric ischemia need early initiation of supportive care.

• #88

  https://www.nursingcenter.com/cearticle?an=00006205-202306000-00005&Journal_ID=54012&Issue_ID=6690539

  Regardless of the specific type, initial treatment should include volume resuscitation with crystalloids to improve perfusion and oxygenation; provision of supplemental oxygen; connection of the nasogastric tube to suction and N.P.O. status for bowel rest; correction of electrolyte abnormalities; and initiation of systemic anticoagulation, unless there are contraindications. […] For suspected acute mesenteric ischemia, regardless of occlusive versus nonocclusive process, NPs should obtain a CTA as previously outlined to confirm diagnosis and attempt to determine cause. […] The treatment process should be commenced according to the following guide based on the cause supported by CTA findings and depending on the presence of clinical signs of peritonitis. […] If acute mesenteric ischemia (regardless of type) is found on CTA and the patient has clinical signs of peritonitis, emergency laparotomy or laparoscopy is typically needed for resection of necrotic bowel. […] Anticoagulation has been shown to improve patient outcomes and is an essential part of treatment for acute mesenteric ischemia.

• #89 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)

• #90 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Although relatively uncommon, mesenteric ischemia is responsible for significant morbidity and mortality in affected individuals. […] The rapid mobilization of a multidisciplinary team consisting of vascular surgeons, general surgeons, intensivists, and radiologists is crucial to address the needs of this critically ill patient population. […] Initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Most importantly, anticoagulation should run continuously and not be paused for surgery. […] A multidisciplinary approach focused on resuscitation and expiated revascularization is critical to ensure optimal outcomes.

• #91 Acute mesenteric ischemia

  https://www.myamericannurse.com/acute-mesenteric-ischemia/

  With a mortality rate exceeding 50%, acute mesenteric ischemia requires prompt nursing identification and vascular intervention. […] Most patients experience acute onset of abdominal pain out of proportion to a physical examination, nausea, vomiting, and melena. […] Prompt surgical evaluation is necessary to identify, minimize, and prevent irreversible intestinal damage. […] However, no specific laboratory studies indicate AMI. Initially, symptoms may be nonspecific, resulting in delayed diagnosis, so astute nursing assessments are critical. Prompt surgical evaluation identifies, minimizes, and prevents irreversible damage irreversible intestinal damage. […] Activation of the RRT facilitated a quick assessment and implementation of evidence-based treatment.

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