I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section.
I’ll try and transfer them here for your enlightenment.
From the June 2010 EMCast. Joe Martinez doing the talking.
4 types of mesenteric ischemia.
- Embolic – classic in the SMA in a patient with AF
- SMA thrombosis - analogous to the ACS of the abdomen. Can be preceded by chronic symptoms of pain following eating; intestinal angina. Often being worked up for malignancy or being treated for ulcer disease. Can progress to plaque rupture and thrombosis with catastrophic ischemia
- Mesenteric vein thrombosis – more insidious in onset. Analogous to the DVT of the abdomen with similar risk factors. Pain becomes more severe when swelling from thrombus in the venous system is enough to impair arterial inflow. NB you need venous phase on the CT to see it (which isn’t always done unless you ask)
- Non-occlusive mesenteric ischemia (NOMI) – low flow states; cardiomyopathys; septic ICU patients on pressors. Treat cause (always a sign that you’re stuffed…) real nasty
Brief review of mesenteric vascular supply
- 3 branches off anterior aorta in abdomen
- Coeliac trunk (with an “o” dammit!)- Upper L1 – Supplies embryonic foregut – lower oesophagus to 2nd part duodenum at pancreatic ampulla
- Superior Mesenteric – Lower L1 – Supplies mid-gut – 2nd part duodenum to distal 1/3 transverse colon
- Inferior Mesenteric – L3 – Supplies hind-gut – distal 1/3 transvers colon to upper rectum