Mesenteric Ischemia

Aka: Mesenteric Ischemia, Acute Mesenteric Ischemia, Mesenteric Infarction, Colonic Ischemia, Intestinal Ischemia, Colonic Vasculitis, Ischemic Colitis, Visceral Artery Ischemia, Acute Intestinal Vascular Insufficiency, Acute Ischemic Enteritis, Ischemic Bowel

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II. Definitions

  1. Acute Mesenteric Ischemia
    1. Sudden interruption of Small Bowel perfusion resulting in Intestinal Ischemia, infarction and necrosis

III. Anatomy

  1. Mesenteric Arteries
    1. Celiac Artery
      1. Foregut (proximal duodenum and Stomach)
      2. Hepatobiliary system
      3. Spleen
    2. Superior Mesenteric Artery
      1. Midgut (Small Intestine and proximal colon to splenic flexure)
    3. Inferior Mesenteric Artery
      1. Hindgut (descending colon, sigmoid colon and Rectum)
  2. Mesenteric Veins
    1. Parallels arterial supply for the most part
    2. Superior Mesenteric Vein
      1. Drains the Small Intestine and proximal colon
    3. Inferior Mesenteric Vein
      1. Drains the hindgut

IV. Pathophysiology

  1. Timing
    1. Mesenteric hypoperfusion
      1. Collateral circulation can compensate for 75% reduced flow for up to 12 hours before major injury
    2. Reversible Mesenteric Ischemia
      1. Mucosal Villi necrosis starts within 3-4 hours from onset of ischemia
    3. Transmural infarction (bowel necrosis and perforation)
      1. Onset within 6 hours of ischemia onset
      2. Intestinal wall may appear edematous
    4. Bowel Hemorrhage, Gangrene and Perforation
      1. Onset within 1-4 days after Mesenteric Ischemia without intervention
      2. Intestinal wall appears edematous, friable and hemorrhagic
  2. Watershed blood supply areas most often affected
    1. Splenic flexure (intersection of SMA and IMA distribution)
    2. Rectosigmoid

V. Epidemiology

  1. Uncommon condition (but requires high index suspicion)
    1. Accounts for 0.1 to 1% of Acute Abdominal Pain admissions
    2. Mortality is as high as 24-94%
    3. Rapid diagnosis is critical to survival
  2. More common in patients over age 60 years old
  3. More common in women (3 fold increased risk over men)

VI. Risk Factors

  1. Advanced age over 60 to 70 years old
  2. Female gender (3 fold increased risk over men)
  3. Intra-Abdominal Cancer
  4. Comorbid Cardiovascular Disease
    1. Atherosclerosis (e.g. Coronary Artery Disease, Peripheral Arterial Disease)
    2. Atrial Fibrillation
      1. Causes 50% of Mesenteric Artery Embolism, and 25% of all Mesenteric Ischemia cases
    3. Dilated Cardiomyopathy
      1. Reduced ejection fraction is a risk for splanchnic Vasoconstriction and Nonocclusive Mesenteric Ischemia (NOMI)
  5. Endocarditis Risk
    1. Valvular Disease
    2. Intravenous Drug Use
  6. Other Comorbidity
    1. Diabetes Mellitus
    2. Hypertension
    3. Renal Insufficiency
    4. Vasculitis
    5. Hypercoagulable state (Mesenteric Venous Thrombosis)
  7. Rapid weight loss (e.g. Anorexia)
    1. Results in decreased fat between duodenum and superior Mesenteric Artery
    2. Ischemia results from duodenal compression of the superior Mesenteric Artery
  8. Critical Illness, Major Surgery or Strenuous Exercise (hypoperfusion outlasts initial insult)
    1. Myocardial Infarction (recent)
    2. Hypovolemia

VII. Causes: Primary Acute Mesenteric Ischemia (intravascular)

  1. Mesenteric Artery Embolism (50%)
    1. Most common embolism source is of cardiac origin (e.g. Atrial Fibrillation, endocarditis, Cardiomyopathy, Myocardial Ischemia)
      1. Atrial Fibrillation is responsible for 50% of cases
    2. Superior Mesenteric Artery Embolism is affected in most cases (large bore vessel with narrow angle branch from aorta)
      1. More than half lodge distal to the middle colic artery origin (typically 6-8 cm from SMA origin)
      2. Affects Midgut (Small Intestine and proximal colon to splenic flexure), sparing the jejunum and colon
  2. Mesenteric Artery Thrombosis (15-25%)
    1. Superior Mesenteric Artery (SMA) thrombosis of stenotic, atherosclerotic vessels, typically at proximal SMA
    2. Often preceded by Chronic Mesenteric Ischemia (postprandial Abdominal Pain and weight loss)
  3. Nonocclusive Mesenteric Ischemia - NOMI (20-30%)
    1. Results from Low Cardiac Output (shock) and mesenteric arterial Vasoconstriction or vasospasm (severe and prolonged)
    2. Causes include Septic Shock, Cardiogenic Shock, Hypovolemic Shock, Cardiomyopathy and Bowel Obstruction with Strangulation
    3. Bowel can compensate for up to 12 hours with increased oxygen extraction, increased capillary recruitment
  4. Mesenteric Venous Thrombosis - MVT (5-10%)
    1. Occurs in Hypercoagulable State or localized intraabdominal inflammation (e.g. Trauma, Pancreatitis, Sepsis, Inflammatory Bowel Disease)
    2. Typically associated with underlying diffuse atherosclerosis and Chronic Mesenteric Ischemia
    3. Most commonly affects the superior mesenteric vein and its branches
    4. Results in bowel wall edema and elevated vascular resistance with secondary decreased arterial flow

VIII. Causes: Primary Chronic Mesenteric Ischemia (abdominal or Intestinal Angina)

  1. See Chronic Mesenteric Ischemia
  2. Presents with postprandial Abdominal Pain, weight loss and food aversion
  3. Diffuse atherosclerotic disease in 95% of cases
    1. All major mesenteric vessels (SMA, IMA, Celiac Artery) with stenosis or Occlusion

IX. Causes: Secondary Mesenteric Ischemia (compression)

  1. Adhesions
  2. Herniation
  3. Volvulus
  4. Intussusception
  5. Tumor
  6. Trauma
  7. Retroperitoneal fibrosis

X. Precautions

  1. Have a low index of suspicion in Abdominal Pain out of proportion in older patients or Atrial Fibrillation

XI. Symptoms

  1. Abdominal Pain (95% of cases)
    1. Severe, colicky or cramping pain, and out of proportion to exam
    2. Pain is poorly localized
    3. Left Lower Quadrant abdominal cramping may occur in Mesenteric Artery Embolism or thrombosis
    4. Epigastric or Periumbilical Pain may occur in Chronic Mesenteric Ischemia
  2. Provocative
    1. Postprandial pain onset 10 to 30 minutes after a meal
  3. Timing
    1. Sudden onset, severe abrupt Abdominal Pain out of proportion to exam
      1. Mesenteric Artery Embolism
      2. Mesenteric Venous Thrombosis
    2. Gradual onset of less severe Abdominal Pain (due to incomplete Occlusion, collaterals)
      1. Mesenteric Artery Thrombosis
      2. Nonocclusive Mesenteric Ischemia (NOMI)
    3. Progressive postprandial pain
            1. Chronic Mesenteric Ischemia
  4. Gastroenteritis-type symptoms (one third of cases)
    1. Diarrhea (35% of cases) progressing to Constipation
      1. Superior Mesenteric Artery Embolism
      2. Superior Mesenteric Artery Thrombosis
    2. Nausea (44% of cases) or Vomiting (35% of cases)
      1. Superior Mesenteric Artery Embolism
      2. Mesenteric Venous Thrombosis
      3. Chronic Mesenteric Ischemia
  5. Chronic Malnutrition, Cachexia or Wasting Syndrome (food avoidance, Malnutrition and weight loss)
    1. Chronic Mesenteric Ischemia (Abdominal Angina)
  6. Associated Findings
    1. Bloody stools (from 10 to 16%, up to 84% of cases)

XII. Signs

  1. Abdominal exam may be benign early in course
    1. Abdominal Pain is typically out of proportion to exam
  2. Peritonitis and systemic features in delayed presentation once infarction and necrosis has occurred (1-3 days after onset)
    1. Acute Abdomen is found in 20 to 25% of cases
    2. Abdominal tenderness to palpation
    3. Fever
    4. Fecal Occult Blood positive in 25% of cases
    5. Ill appearance
  3. Other findings
    1. Abdominal bruit (>17% of cases)

XIII. Labs: Diagnosis

  1. Precautions
    1. No laboratory test has Test Sensitivity or Test Specificity to rule-in or rule-out Mesenteric Ischemia
  2. Serum lactate
    1. Most useful laboratory test when considering Mesenteric Ischemia as a diagnosis, as well as serial re-testing
    2. Elevated Lactic Acid in Mesenteric Ischemia suggests severe segmental ischemia or infarction has already occurred
    3. Normal Lactic Acid does not exclude Mesenteric Ischemia, and intervention is ideally before Lactic Acid rises
    4. Test Sensitivity: 86%
    5. Test Specificity: 44%
    6. Cudnik (2013) Acad Emerg Med 20(11): 1087-1100 [PubMed]
  3. Complete Blood Count (CBC)
    1. Leukocytosis >15k (and often over 20k) with Left Shift is common (may be absent in Immunocompromised patients)
  4. Other labs abnormal if prolonged bowel ischemia, infarction, necrosis or perforation occurs
    1. Arterial Blood Gas (ABG) or Venous Blood Gas (VBG) with Metabolic Acidosis
    2. Serum Amylase increased
    3. Serum Phosphate Level
      1. Increases within 4 hours (75%)
    4. Procalcitonin increased
      1. Cosse (2014) World J Gastroenterol 20(47): 17773-8 [PubMed]
    5. D-Dimer increased
      1. D-Dimer, although non-specific, is elevated in most Mesenteric Ischemia cases
      2. May be useful for its high Negative Predictive Value (unlikely to be Mesenteric Ischemia when negative)
      3. Block (2008) Scand J Clin Lab Invest 68(3): 242-8 [PubMed]
    6. Intestinal Fatty Acid Binding Protein (I-FABP)
      1. I-FABP is released from injured intestinal mucosal villi
      2. Not available outside of experimental protocols as of 2022
      3. Test Sensitivity: 80%
      4. Test Specificity: 86%
      5. Montagnana (2018) Ann Transl Med 6(17): 341 [PubMed]
  5. Malnutrition Labs in Chronic Mesenteric Ischemia
    1. Anemia
    2. Leukopenia or Lymphopenia
    3. Hypoalbuminemia
  6. Electrocardiogram (EKG)
    1. Obtain in all patients with suspected Mesenteric Ischemia

XIV. Labs: Other to Evaluate Differential Diagnosis and Comorbidities

  1. Comprehensive metabolic panel (e.g. Chem18)
    1. Serum Electrolytes
    2. Renal Function tests
      1. Blood Urea Nitrogen (BUN)
      2. Serum Creatinine
    3. Liver Function Tests (LFT)
      1. AST increased
  2. Sepsis and Ischemia related labs
    1. Lactic Acid (marker of bower ischemia or infarction)
      1. Normal Lactic Acid dose not exclude Mesenteric Ischemia
    2. Blood Cultures
    3. Urinalysis and Urine Culture
  3. Coagulation Studies
    1. ProTime (INR)
    2. Partial Thromboplastin Time (PTT)
    3. Consider Hypercoagulable lab studies in Mesenteric Venous Thrombosis
  4. Miscellaneous
    1. Lactate Dehydrogenase (LDH) Increased
    2. Creatine Phosphokinase (CK-MM) Increased
    3. Serum Lipase
    4. Type and Cross Match Blood

XV. Differential Diagnosis

  1. See Acute Abdominal Pain
  2. See Acute Abdominal Pain Causes
  3. See Abdominal Pain in Older Adults

XVI. Imaging: Advanced (Preferred)

  1. CT Abdomen Pelvis with CT Angiography
    1. First-line study in most cases
    2. Perform with CT angiography timing and contrast load to best assess bowel perfusion
      1. Thin slices (1 to 3 mm)
      2. Do not use Oral Contrast (obscures mesenteric vessels and bowel wall enhancement)
    3. Efficacy
      1. Test Sensitivity: 71-96%
      2. Test Specificity: 92-94%
    4. Progression of bowel changes in Mesenteric Ischemia
      1. Mesenteric Edema and stranding
      2. Bowel dilation
      3. Bowel wall thickening (edema, Hemorrhage)
      4. Bowel wall gas (pneumotosis intestinalis) and Portal Vein gas in necrosis
    5. Findings in Mesenteric Venous Thrombosis
      1. Best performed with two-phase imaging (enhances visceral venous drainage)
      2. Mesenteric vein or Portal Vein engorgement
      3. Visceral edema
    6. Findings in Mesenteric Occlusion
      1. Mesenteric Artery Thrombosis will demonstrate proximal stenosis or Occlusion of SMA, IMA or Celiac Artery
      2. Mesenteric Artery Embolism related Occlusion site is more difficult to identify on CT
    7. Findings in Nonocclusive Mesenteric Ischemia (NOMI)
      1. Segmental narrowing of major arteries
      2. Small vessel decreased flow
  2. Angiography (gold standard)
    1. Largely replaced by CT, but indicated in unclear cases (e.g. embolus)
    2. Also indicated for intervention
    3. Best defines Occlusion and stenosis sites
      1. Anteroposterior Views (collateral pathways)
      2. Lateral Views (visceral branches)
  3. Contrast-Enhanced MRA Abdomen
    1. Contrast-Enhanced MRA may be best modality to fully evaluate for abdominal vascular disease
    2. However, multiple limitations (beyond long scan times and decreased availability compared with CT)
      1. Poorly evaluates distal mesenteric vessels
      2. Poor sensitivity for bowel wall thickening or mesenteric stranding
    3. Indications (typically non-emergent evaluation)
      1. Limited use in the acute setting
      2. Chronic Mesenteric Ischemia (ideal imaging)
      3. Acute Mesenteric Venous Thrombosis
      4. Intravenous Contrast dye allergy
  4. Mesenteric Duplex Ultrasound
    1. Evaluates only proximal, main vessels (SMA, IMA and Celiac Artery), identifying high peak systolic velocity
    2. Consider in suspected Chronic Mesenteric Ischemia
    3. Test Sensitivity: 70-89%
    4. Test Specificity: 92-100% (approaches 100% for SMA Occlusion)
    5. Ultrasound is useful in combination with angiography following visceral bypass graft or endovascular stenting
    6. Limited Test Sensitivity due to overlying bowel gas that may interfere with study

XVII. Imaging: Abdominal XRay (or KUB, Kidney-ureter-Bladder)

  1. Advanced imaging (see above) is always preferred when available
  2. XRay is listed for historical purposes and in low resource centers
  3. Findings suggestive of Mesenteric Ischemia (20-60%)
    1. Adynamic Ileus
    2. Thumb printing of bowel wall
      1. Suggests mucosal and submucosal edema or Hemorrhage
      2. Multiple round, smooth, soft tissue markings in the bowel lumen
    3. Bowel wall thickening
  4. Findings suggestive of intestinal infarction (late finding)
    1. Air in bowel wall (Pneumatosis Intestinalis)
    2. Air in Portal Vein
  5. Other conditions identified
    1. Small Bowel Obstruction
      1. Air-fluid levels
      2. Fixed dilated loops of bowel
    2. Volvulus
    3. Viscus perforation

XVIII. Management: General

  1. Immediate Vascular Surgery Consultation (or General Surgery if not available)
  2. Beyond general supportive care, management differs depending on cause
    1. Mesenteric Artery Embolism
    2. Mesenteric Artery Thrombosis
    3. Nonocclusive Mesenteric Ischemia (NOMI)
    4. Mesenteric Venous Thrombosis (MVT)
    5. Chronic Mesenteric Ischemia
  3. Supportive care to increase perfusion and oxygenation
    1. Aggressive Intravenous Fluid hydration to stabilize hemodynamic status
      1. Adjust based on hemodynamic monitoring parameters
      2. Large fluid volumes are often required (>10 Liters on day 1 in some cases)
      3. Avoid Vasopressors in general
        1. May consider in Hypotension and volume overload
        2. May consider in prevention of Abdominal Compartment Syndrome
        3. If used, consider low dose Dopamine, Dobutamine or Milrinone (less mesenteric Vasoconstriction)
    2. Consider Blood Transfusion in Anemia
    3. Administer Supplemental Oxygen
    4. Correct acid-base and Electrolyte abnormalities
      1. Serially follow Electrolytes (e.g. Hyperkalemia)
      2. Serially follow Venous Blood Gas (risk of severe Metabolic Acidosis)
  4. Infection control
    1. Mesenteric Ischemia disrupts the mucosal barrier and allows for Bacterial translocation and Sepsis risk
    2. Start empiric broad spectrum Antibiotics to cover Gram-Negative Bacteria and Anaerobic Bacteria
      1. Piperacillin and Tazobactam (Zosyn) OR
      2. Ceftriaxone AND Metronidazole
  5. Other general measures
    1. Nasogastric suction (NG tube)
    2. Opioid Analgesics
    3. Heparin Anticoagulation indications
      1. Acute Mesenteric Ischemia
      2. Chronic Mesenteric Ischemia with exacerbation
  6. Discontinue Vasoconstricting medications
    1. Discontinue Vasopressors
    2. Discontinue Digitalis
    3. Discontinue Beta Blockers
  7. Stabilize concurrent cardiovascular disease
    1. Congestive Heart Failure
    2. Cardiac Arrhythmia

XIX. Management: Surgical

  1. Consult Vascular Surgery or General Surgery
  2. Indications for emergent exploratory laparotomy
    1. Acute Abdomen with peritoneal signs or peritonitis
    2. Intestinal infarction
    3. Intestinal perforation
    4. Gastrointestinal Bleeding
  3. Open Surgery
    1. Exploratory laparotomy
      1. Assess for bowel viability
        1. Intraoperative Doppler Ultrasound
        2. Flourescein IV infusion with exam of bowel under wood lamp
      2. Resection of necrotic bowel
      3. Revascularization
        1. Evaluate carefully for revascularization options and revascularize where possible
        2. Surgical embolectomy for proximal Superior Mesenteric Artery Embolism
    2. Complications
      1. Second-look surgery is often needed after initial stabilization (>50% of cases)
      2. Open surgery is associated with longer hospital stay and prolonged recovery compared with endovascular repair
      3. Short-term or in-hospital mortality: 26 to 65%
        1. Increased mortality in advanced age, delayed intervention, Metabolic Acidosis, Renal Insufficiency
  4. Endovascular Repair
    1. Indicated in high risk patients with severe comorbidity
    2. Revascularization via thrombectomy or Angioplasty with stenting (87% successful)
    3. Short-term or in-hospital mortality: 25%
    4. Beaulieu (2014) J Vasc Surg 59(1): 159-64 [PubMed]

XX. Prognosis

  1. Mortality: 24-94%

XXI. Complications

  1. Bowel Necrosis and perforation
  2. Septic Shock
  3. Abdominal Compartment Syndrome
  4. Death

XXII. References

  1. Fraboni (2012) Board Review Express, San Jose
  2. Birnbaumer (2001) CMEA Medicine Lecture, San Diego
  3. Kern and Gilley-Avramis (2022) Crit Dec Emerg Med 36(11) 21-8
  4. Harward (1989) J Vasc Surg 9(2): 328-32 [PubMed]
  5. Jamieson (1982) Br J Surg 69:S52 [PubMed]
  6. Kairaluoma (1977) Am J Surg 133:188 [PubMed]
  7. Mastoraki (2021) World J Gastrointest Pathophysiol 7(1): 125-30 [PubMed]
  8. Wolk (1981) Int Surg 65(3):231 [PubMed]

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Related Studies

Ontology: Acute vascular insufficiency of intestine (disorder) (C0001363)

Concepts Disease or Syndrome (T047)
ICD9 557.0
SnomedCT 196998009, 197004007, 91489000
English Acute GIT vasc.insuffic NOS, Acute intest vasc insuff, Acute intestinal vascular insufficiency NOS, AMI - Acute mesenteric ischaem, Acute vascular insufficiency of intestine (disorder), acute vascular insufficiency of intestine (diagnosis), acute vascular insufficiency of intestine, Ac vasc insuff intestine, acute mesenteric ischemia, acute intestinal ischaemia, acute ischemia mesenteric, acute mesenteric ischaemia, Acute intestinal vascular insufficiency NOS (disorder), Acute vascular insufficiency of intestine, Acute intestinal ischaemia, Acute intestinal ischemia, Acute intestinal vascular insufficiency, Acute mesenteric ischaemia, Acute mesenteric ischemia, AMI - Acute mesenteric ischaemia, AMI - Acute mesenteric ischemia, Acute intestinal ischaemic syndrome, Acute intestinal ischemic syndrome, ischemia; bowel, acute, Acute intestinal ischemic syndrome, NOS, Acute vascular insufficiency of intestine, NOS, Acute Intestinal Ischemia
Dutch acute vasculaire insufficiëntie van de ingewanden, ischemie; darm, acuut
French Insuffisance intestinale aiguë vasculaire
German akute vaskulaere Insuffizienz des Darms
Portuguese Insuficiência vascular aguda do intestino
Spanish Insuficiencia vascular aguda del intestino, insuficiencia vascular intestinal aguda, SAI (trastorno), insuficiencia vascular intestinal aguda, SAI, insuficiencia vascular aguda del intestino (trastorno), insuficiencia vascular aguda del intestino, síndrome de isquemia intestinal aguda
Japanese 急性腸血行不全, ｷｭｳｾｲﾁｮｳｹｯｺｳﾌｾﾞﾝ
Italian Insufficienza vascolare acuta dell'intestino
Czech Akutní cévní nedostatečnost střeva
Hungarian Bél acut vascularis elégtelensége
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Gastrointestinal tract vascular insufficiency (C0156149)

Concepts Disease or Syndrome (T047)
SnomedCT 266521006, 155768005, 312607004
English GIT vascular insuffic. NOS, Gastrointestinal tract vascular insufficiency, GI tract vasculr insufficiency, intestinal ischaemia, intestinal ischemia, ischemia bowel, ischemia intestinal, insufficiency intestine vascular, bowel ischaemia, ischemic bowel disease, bowel ischemia, Gastrointestinal tract vascular insufficiency NOS (disorder), GIT vascular insufficiency NOS, GIT vascular insuffic. NOS (disorder), Gastrointestinal tract vascular insufficiency NOS, Gastrointestinal tract vascular insufficiency (disorder)
Spanish insuficiencia vascular del tracto gastrointestinal, SAI (trastorno), insuficiencia vascular del tracto gastrointestinal, SAI, GIT vascular insuffic. NOS, insuficiencia vascular del tracto gastrointestinal (trastorno), insuficiencia vascular del tracto gastrointestinal
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Colitis, Ischemic (C0162529)

Definition (MSH) Inflammation of the COLON due to colonic ISCHEMIA resulting from alterations in systemic circulation or local vasculature.
Concepts Disease or Syndrome (T047)
MSH D017091
ICD10 K55.9
SnomedCT 30588004
English Ischemic Colitis, Colitis, Ischemic, ischemic colitis (diagnosis), ischemic colitis, Colitis ischaemic, Colitis ischemic, Colitis, Ischemic [Disease/Finding], colitis ischaemic, colitis ischemic, colonic ischemia, Ischemic colitis, Colonic ischaemia, Colonic ischemia, Ischaemic colitis, Ischemic colitis (disorder), colitis; ischemic, ischemic; colitis, Ischemic colitis, NOS, Ischaemic colitis, NOS, Colitis;ischaemic, Colitis;ischemic, ischaemic colitis
German ischaemische Kolitis, Kolitis ischaemisch, Colitis ischaemica, Dickdarmentzündung, ischämische, Ischämische Kolitis, Kolitis, ischämische
Swedish Kolit, ischemisk
Japanese ｷｮｹﾂｾｲﾀﾞｲﾁｮｳｴﾝ, 虚血性大腸炎, 大腸炎-虚血性, 乏血性大腸炎
Czech kolitida ischemická, Ischemická kolitida, ischemická kolitida
Finnish Iskeeminen koliitti
Russian ISHEMICHESKII KOLIT, KOLIT ISHEMICHESKII, ИШЕМИЧЕСКИЙ КОЛИТ, КОЛИТ ИШЕМИЧЕСКИЙ
Polish Zapalenie okrężnicy niedokrwienne
Hungarian Vastagbélgyulladás ischaemiás, Ischaemiás colitis, Ischaemiás vastagbélgyulladás
Norwegian Iskemisk kolitt
Dutch colitis; ischemisch, ischemie; colitis, ischemische colitis, Colitis, ischemische, Ischemische colitis
Spanish colitis isquémica (trastorno), colitis isquémica, isquemia colónica, isquemia cólica, Colitis isquémica, Colitis Isquémica
Portuguese Colite isquémica, Colite Isquêmica
French Colite ischémique
Italian Colite ischemica
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Acute ischemic enteritis (C0267399)

Concepts Disease or Syndrome (T047)
SnomedCT 33906009
English acute ischemic enteritis (diagnosis), acute ischemic enteritis, Acute ischemic enteritis, Acute ischaemic enteritis, Acute ischemic enteritis (disorder), enteritis; ischemic, acute, ischemic; enteritis, acute
Dutch enteritis; ischemisch, acuut, ischemisch; enteritis, acuut
Spanish enteritis isquémica aguda (trastorno), enteritis isquémica aguda
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Mesenteric infarction (C0267406)

Concepts Disease or Syndrome (T047)
SnomedCT 3558002
Dutch infarct mesenterisch, infarct; mesenteriaal, mesenteriaal; infarct
French Infarctus mésentérique
German Mesenterialinfarkt
Italian Infarto mesenterico
Portuguese Enfarte mesentérico
Spanish Infarto mesentérico, infarto mesentérico (trastorno), infarto mesentérico
Japanese 腸間膜梗塞, ﾁｮｳｶﾝﾏｸｺｳｿｸ
English mesenteric infarction (diagnosis), mesenteric infarction, Infarction mesenteric, Mesenteric infarction, Mesenteric infarction (disorder), infarction; mesenteric, mesenteric; infarction, Mesenteric infarction, NOS
Czech Infarkt střeva
Hungarian Infarctus mesentericus
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Visceral arterial ischaemia (C0853812)

Definition (NCI_CTCAE) A disorder characterized by a decrease in blood supply due to narrowing or blockage of a visceral (mesenteric) artery.
Definition (NCI) Decreased blood supply to the small or large intestine due to narrowing or blockage of a visceral (mesenteric) artery. The ischemia results to the damage of the intestinal tissues. It may be chronic, caused by atherosclerosis or acute, secondary to the formation of a thrombus or embolus in the mesenteric arterial lumen. In chronic ischemia, patients present with abdominal pain manifested in a short time after a meal and weight loss. In acute ischemia, patients present with sudden and acute abdominal pain, nausea and vomiting, and blood in the stool.
Concepts Disease or Syndrome (T047)
Italian Ischemia viscerale arteriosa
French Ischémie viscérale artérielle, Ischémie viscérale
Japanese 内臓動脈虚血, ﾅｲｿﾞｳﾄﾞｳﾐｬｸｷｮｹﾂ
Czech Viscerální tepenná ischemie, Viscerální arteriální ischemie
English Visceral arterial ischaemia, Visceral arterial ischemia, Visceral Artery Ischemia, Mesenteric Artery Ischemia
Hungarian Visceralis arteriás ischaemia, Arteriás visceralis ischaemia
Portuguese Isquemia arterial visceral
Spanish Isquemia arterial visceral
Dutch viscerale arteriële ischemie
German Viszeralarterienischaemie
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Ischaemic colitis (SMQ) (C2242744)

Definition (MDRCZE) Ischemická kolitida je poranění tlustého střeva, které je důsledkem přerušení dodávek krve k němu. Je způsobeno přechodným snížením průtoku krve do tračníku. Většina pacientů jsou staré osoby, ale ke kolitidě dochází i v ranějším věku ve spojení s užíváním orální antikoncepce, vaskulitidou a hyperkoagulabilními stavy. Klinický obraz závisí na stupni a míře vývoje ischémie. Akutní fulminantní ischemická kolitida: těžká bolest v dolní části břicha, krvácení z konečníku a hypotenze; dilatace tračníku (závažné případy); známky peritonitidy (závažné případy).Subakutní ischemická kolitida: nejběžnější klinická varianta; vyvolává menší stupně bolesti a krvácení (které trvají několik dní nebo týdnů).Ischemická kolitida je druhá nejčastější příčina dolního gastrointestinálního krvácení. Diagnóza se provádí pomocí kolonoskopie. Obvykle se vyvíjí za nepřítomnosti okluze hlavních cév. Přidružené faktory: snížený srdeční objem; arythmie; trauma; chirurgický zákrok (např. aorto-iliakální chirurgický zákrok; vaskulitida; poruchy koagulace; chronická obstruktivní pulmonální choroba; syndrom dráždivého střeva; specifické léky. Více než dvě třetiny pacientů reagují na konzervativní opatření (intravenózně podávané tekutiny, uklidnění střev, antibiotika).Chirurgický zákrok nutný jen vzácně.
Definition (MDRJPN) 虚血性大腸炎は大腸への血液供給が妨害されることによって生じる大腸の損傷である。結腸に対する血流の一過性の減少により生じる。老齢の患者が多いが、同時に経口避妊薬服用、血管炎、あるいは凝固亢進状態に伴う若年層にも生じる。臨床像は虚血進展の程度と頻度による。急性劇症虚血性大腸炎：重度の下腹部痛、直腸からの出血、および血圧低下；結腸の拡張（重症例）；腹膜炎の徴候（重症例）。亜急性虚血性大腸炎：臨床像は多様である；それほど強くない痛みと出血（数日から数週におよぶことがある）。虚血性大腸炎は下部消化管出血の２番目に多い原因である。診断は大腸内視鏡検査でなされる。通常は主要血管の閉塞を伴わずに発症する。関連する要因として：心伯出量の低下；不整脈；外傷；手術（例：大動脈-腸骨動脈手術）；血管炎；凝固系の障害；慢性閉塞性肺疾患；過敏性腸症候群；特定の薬剤。３分の２以上の患者は保存的治療法（点滴療法、腸管安静、抗生物質）に反応し、手術が必要とされることは稀である。
Definition (MDRHUN) Az ischaemias colitis a vastagbél sérülése, ami a vérellátásának interruptiojából ered. A véráramlás a colon irányába történő átmeneti csökkenése okozza. A legtöbb páciens az idősebb korosztályba tartozik, de fiatalabb korban is jelentkezik orális fogamzásgátló szerek alkalmazása, vasculitis és hypercoagulabilis állapotok esetén. A klinikai képe az ischaemia fokának és előrehaladottságának függvénye. Acut fulminans ischaemias colitis: súlyos alhasi fájdalom, végbélvérzés és hypotensio; vastagbéltágulat (súlyos esetek).Subacut ischaemias colitis: leggyakoribb klinikai variáns; kisebb mértékű fájdalmat és vérzést produkál (több napon vagy héten keresztül jelentkezik).Az ischemiás colitis a gastrointestinalis traktus alsóbb szakaszaiban jelentkező vérzés második leggyakoribb oka. Kolonoszkópiával felállított diagnózis. Általában nagyobb érelzáródás nélkül fejlődik ki. Társtényezők: csökkent szívperctérfogat; arrhythmia; trauma; műtét (pl. aortoiliacalis műtét); vasculitis; véralvadási betegségek; chronicus obstructiv pulmonalis betegség; irritabilis bél syndroma; speciális gyógyszerek. A páciensek több mint kétharmada reagál a konzervatív kezelésre (iv. folyadékpótlás, bél pihentetése, antibiotikumok) Sebészeti beavatkozás csak ritkán szükséges.
Definition (MDR) Ischaemic colitis is injury of large intestine that results from interruption of its blood supply. Caused by transient reduction in blood flow to colon. Most patients are elderly, but also occurs in younger ages associated with oral contraceptive use, vasculitis, hypercoagulable states. Clinical picture depends on degree and rate of development of ischemia. Acute fulminant ischaemic colitis: severe lower abdominal pain, rectal bleeding, and hypotension; dilatation of colon (severe cases); signs of peritonitis (severe cases). Subacute ischaemic colitis: most common clinical variant; produces lesser degrees of pain and bleeding (occurring over several days or weeks). Ischemic colitis is second most common cause of lower gastrointestinal bleeding. Diagnosis made by colonoscopy. Usually develops in absence of major vessel occlusion. Associated factors: decreased cardiac output; arrhythmia; trauma; surgery (e.g., aorto-iliac surgery); vasculitis; coagulation disorders; chronic obstructive pulmonary disease; irritable bowel syndrome; specific drugs. More than two thirds of patients respond to conservative measures (IV fluids, bowel rest, antibiotics). Surgery rarely required
Definition (MDRSPA) La Colitis isquémica es la lesión del intestino grueso que resulta de la interrupción del suministro de sangre a dicha área. Se produce cuando hay una reducción transitoria de flujo sanguíneo en el colon. La mayoría de los pacientes son de edad avanzada, pero también ocurre en los de menor edad asociados con la utilización de anticonceptivos orales, vasculitis y estados de hipercoagulibilidad. El cuadro clínico depende del grado y la velocidad de desarrollo de la isquemia. Colitis isquémica aguda fulminante: Dolor intenso en la parte inferior del abdomen, sangrado rectal e hipotensión; dilatación del colon (casos graves); signos de peritonitis (casos graves).Colitis isquémica subaguda: La variante clínica más común; produce grados menores de dolor y sangrado (ocurre en el transcurso de varios días o semanas) La colitis isquémica es la segunda causa más común de sangrado en el tracto GI inferior. El diagnóstico se hace mediante colonoscopia. Suele desarrollarse en ausencia de oclusión de un vaso principal. Factores asociados: Gasto cardiaco disminuido; arritmia; traumatismo; cirugía (p.ej., cirugía aorto-iliaca); vasculitis; trastornos de la coagulación; enfermedad pulmonar obstructiva crónica; síndrome del instestino irritable; fármacos específicos. Más de dos tercios de los pacientes responden a medidas conservadoras (administración IV de líquidos, dieta absoluta oral, antibióticos).Casi nunca es necesaria la cirugía
Definition (MDRITA) La colite ischemica è una lesione dell'intestino crasso che risulta dall'interruzione dell'apporto ematico. Causata da riduzione temporanea del flusso ematico al colon. La maggior parte dei pazienti è di età avanzata, ma si manifesta anche in età più giovane associata con uso di contraccettivi orali, vasculite e stati di ipercoagulabilità. Il quadro clinico dipende dal grado e dal tasso di sviluppo dell'ischemia. Colite ischemica acuta fulminante: grave dolore del basso addome, sanguinamento rettale e ipotensione; dilatazione del colon (casi gravi); segni di peritonite (casi gravi).Colite ischemica subacuta: variante clinica più comune; produce livelli più bassi di dolore e sanguinamento (che si manifestano per diversi giorni o settimane).La colite ischemica è la seconda causa più comune di sanguinamento gastrointestinale inferiore. La diagnosi può essere fatta tramite colonoscopia. Generalmente si sviluppa in assenza di occlusione dei grandi vasi. Fattori associati: riduzione della gittata cardiaca, aritmia, trauma, intervento chirurgico (ad es.: intervento del distretto aorto-iliaco), vasculite, patologie della coagulazione, malattia polmonare ostruttiva cronica, sindrome dell'intestino irritabile, farmaci specifici. Più dei due terzi dei pazienti rispondono a misure conservative (fluidi per endovena, riposo intestinale, antibiotici).Raramente è necessario un intervento chirurgico
Definition (MDRFRE) La colite ischémique est une lésion du gros intestin provoquée par une interruption de l'irrigation sanguine régionale. Provoquée par une réduction transitoire du flux sanguin du côlon. La plupart des patients sont âgés, mais cela peut se produire chez les personnes de plus jeune âge en association à la prise de contraceptifs oraux, une vascularite et des états hypercoagulables. Le tableau clinique dépend du degré et du taux de progression de l'ischémie. Colite ischémique fulminante aiguë : Douleurs intenses du bas abdomen, saignement rectal et hypotension ; dilatation du côlon (cas graves) ; signes de péritonite (cas graves).Colite ischémique subaiguë : Forme la plus répandue; douleurs et saignement moins intenses (se produisant sur plusieurs jours ou semaines).La colite ischémique est la deuxième cause la plus répandue de saignement du tractus gastro-intestinal inférieur. Le diagnostic est établi par coloscopie. Se développe généralement en l'absence d'une occlusion de vaisseau principal. Facteurs associés : Sortie cardiaque diminuée ; arythmie ; traumatisme ; chirurgie (par exemple, chirurgie aorto-iliaque) ; vascularite ; troubles de la coagulation ; Bronchopneumopathie chronique obstructive ; côlon irritable ; médicaments spécifiques. Plus de deux tiers des patients ont une réponse positive aux mesures conventionnelles (liquides IV, repos intestinal, antibiothérapie).Une intervention chirurgicale est rarement nécessaire.
Definition (MDRDUT) Ischemische colitis is letsel van de dikke darm die het gevolg is van een onderbreking in de aanvoer van bloed. Wordt veroorzaakt door een voorbijgaande vermindering in de bloedflow naar de colon. De meeste patiënten zijn op hogere leeftijd, maar de aandoening treedt tevens op bij jongere mensen in verband met gebruik van orale anticonceptiva, met vasculitis en met hypercoaguleerbare condities Het klinische beeld hangt af van de mate en de snelheid van de ontwikkeling van ischemie. Acute fulminante ischemische colitis: hevige onderbuiksbijn, rectale bloeding en hypotensie; dilatatie van de colon (ernstige gevallen); tekenen van peritonitis (ernstige gevallen).Subacute ischemische colitis: de meest veelvoorkomende klinische variant; produceert minder hevige pijn en bloeding (treedt op in het verloop van diverse dagen of weken).Ischemische colitis is de op een na meest voorkomende oorzaak van bloedingen in het onderste maag-darmstelsel. De diagnose wordt gesteld middels een colonoscopie. Ontwikkelt zich gewoonlijk in afwezigheid van occlusie van de grote bloedvaten. Aanverwante factoren: verlaagd hartminuutvolume; aritmie; trauma; chirurgie (bijv. chirurgie van a. iliaca); vasculitis; coagulatieaandoeningen; chronisch aspecifieke respiratoire aandoening; irritable-bowel syndrome; specifieke geneesmiddelen. Meer dan twee derde van de patiënten reageert op conservatieve maaatregelen (intraveneuze vloeistoffen, rust voor de ingewanden, antibiotica).Chirurgie is zelden nodig
Definition (MDRGER) Ischämische Kolitis ist eine Verletzung des Dickdarms, die aus einer Unterbrechung der Blutversorgung herrührt. Verursacht durch transiente Verringerung des Blutflusses zum Kolon. Die meisten Patienten sind älter. Allerdings tritt sie auch bei Patienten jüngeren Alters in Verbindung mit Ovulationshemmern, Vaskulitis und Hyperkoagulationszuständen. Krankheitsbild häng vom Ausmaß und der Entwicklungsrate der Ischämie ab. ? Akute fulminante ischämische Kolitis: Schwere Schmerzen im Unterbauch, Rektalblutung und Hypotension, Dilatation des Kolon (schwere Fälle), Zeichen von Bauchfellentzündung (schwere Fälle).? Subkutane ischämische Kolitis: Häufigste klinische Erscheinungsform, verursacht weniger Schmerzen und Bluten (tritt über mehrere Tage oder Wochen auf).Ischämische Kolitis ist die zweithäufigste Ursache von Blutungen im unteren Gastrointestinaltrakt. Diagnosis geschieht mittels Koloskopie. Entwickelt sich gewöhnlich bei Abwesenheit von Verschluss großer Gefäße. Assoziierte Faktoren:? Verringertes Herzzeitvolumen, Herzrhytmusstörungen, Trauma, Operation (z. B. aortoiliakale Operation), Vaskulitis, Koagulationsstörungen, Chronisch obstruktive Lungenerkrankung (COPD), Reizdarmsyndrom, spezielle Arzneimittel. Mehr als zwei Drittel der Patienten sprechen auf konservative Maßnahmen an (IV-Flüssigkeiten, Darmruhe, Antibiotika).Operation is selten erforderlich.
Definition (MDRPOR) A colite isquémica é a lesão do intestino grosso que resulta da interrupção da circulação do sangue nessa área. É causada pela redução transitória do fluxo sanguíneo no cólon. A maioria dos doentes são idosos, mas também ocorre em idades menos avançadas, em associação com a utilização de anticoncepcionais orais, vasculite e estados de hipercoagulação. O quadro clínico depende do grau e do ritmo de desenvolvimento da isquemia. Colite isquémica aguda fulminante: dor intensa na parte inferior do abdómen, sangramento rectal e hipotensão; dilatação do cólon (casos graves); sinais de peritonite (casos graves).Colite isquémica subaguda: a variante clínica mais comum; produz graus menores de dor e sangramento (ocorre durante um período de vários dias ou semanas) A colite isquémica é a segunda causa mais comum de sangramento do tracto gastrointestinal inferior. O diagnóstico é feito por colonoscopia. Costuma desenvolver-se na ausência de oclusão de um vaso principal. Factores associados: débito cardíaco dimínuido; arritmia; traumatismo; cirurgia (p.ex., cirurgia aorto-ilíaca); vasculite; perturbações da coagulação; doença pulmonar obstrutiva crónica; síndrome de intestino irritável; fármacos específicos. Mais de dois terços dos pacientes respondem a medidas conservadoras (administração de líquidos por IV, dieta absoluta oral, antibióticos).A cirurgia quase nunca é necessária
Concepts Classification (T185)
English Ischaemic colitis (SMQ), Ischemic colitis (SMQ)
Spanish Colitis isquémica (SMQ)
Italian Colite ischemica (SMQ)
French Colite ischémique (SMQ)
Dutch Ischemische colitis (SMQ)
German Ischaemische Kolitis (SMQ)
Portuguese Colite esquémica (SMQ)
Czech Ischemická kolitida (SMQ)
Japanese 虚血性大腸炎（ＳＭＱ）
Hungarian Ischaemiás colitis (SMQ)
Derived from the NIH UMLS (Unified Medical Language System)

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