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Acute Intestinal Ischemia
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Intestinal
ischemia
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- The superior mesenteric artery, a large vessel
that branches off the aorta, supplies part of the
intestine with blood. When a blood clot lodges in this artery
or its branches, it cuts of the blood supply to part of the
intestine. This is known as intestinal ischemia. When this
occurs, the intestine may infarct
(die).
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- Crampy or steady upper abdominal
pain
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- Embolic -- blood clots are thrown
from the heart due to heart valve disease or atrial
fibrillation
- Thrombosis --
blood
clots form in the blood vessels
- Vascular insufficiency -- insufficient blood is being pumped to the arteries of the intestine. This can occur in patients with Congestive Heart Failure recently started on
Digoxin.
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- Classically, pain is out of proportion to the exam
- Low Blood Pressure may be present
- Laboratory:
- Elevated white blood cell count
- Arterial Lactic acid level may be elevated
- Angiography -- dye injected and X-Rays taken to determine area of
embolism
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- Broad spectrum intravenous
antibiotics to cover bowel flora, e.g.,
Ampicilin/Gentamicin/Flagyl
- Optimize blood pressure and blood
oxygenation
- Surgical removal of necrotic (dead)
bowel
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- This is a life-threatening illness
and immediate emergency medical treatment is
needed.
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