Difference between revisions of "Mesenteric ischemia history and symptoms"

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==Overview==
 
==Overview==
The hallmark of mesenteric ischemia is 'abdominal pain out of proportion to the examination findings'. A positive history of chronic heart disease and old age is suggestive of mesenteric ischemia . The most common symptoms of mesenteric ischemia include excruciating abdominal pain, altered bowel movements, and .Symptoms of chronic mesenteric ischemia caused by [[atherosclerosis]] include abdominal pain after eating and diarrhea, while that of acute mesenteric artery ischemia due to an embolus include diarrhea, sudden severe abdominal pain, and vomiting.
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The hallmark of [[mesenteric ischemia]] symptoms  is '[[abdominal pain]] out of proportion to the examination findings'. A positive history of chronic [[cardiovascular]] disorder, old age and [[abdominal pain]] is suggestive of mesenteric ischemia, unless proven otherwise. The most common symptoms of [[mesenteric ischemia]] include excruciating [[Abdomen|abdominal]] pain, [[Dysentery|bloody diarrhea]], and [[Nausea and vomiting|nausea]]/[[Nausea and vomiting|vomiting]]. Symptoms of [[chronic]] [[Mesenteric ischemia|mesenteric]] [[ischemia]] caused by [[atherosclerosis]] include [[Abdomen|abdominal]] pain after eating and [[diarrhea]], while that of [[acute]] [[Mesenteric ischemia|mesenteric]] [[ischemia]] due to an [[Embolism|embolus]] include [[diarrhea]], sudden severe [[Abdominal pain|abdominal]] pain, and [[Nausea and vomiting|vomiting]].
  
 
==History==
 
==History==
Patients suffering from mesenteric ischemia may have a positive history of:
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Patients suffering from mesenteric ischemia may have a positive history of:<ref name="pmid22305578">{{cite journal| author=Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ| title=The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds. | journal=Am J Med | year= 2012 | volume= 125 | issue= 4 | pages= 394-8 | pmid=22305578 | doi=10.1016/j.amjmed.2011.09.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22305578  }} </ref><ref name="pmid15833694">{{cite journal| author=Sreenarasimhaiah J| title=Chronic mesenteric ischemia. | journal=Best Pract Res Clin Gastroenterol | year= 2005 | volume= 19 | issue= 2 | pages= 283-95 | pmid=15833694 | doi=10.1016/j.bpg.2004.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15833694  }} </ref>
  
 
{| class="wikitable"
 
{| class="wikitable"
!Personal history
+
! align="center" style="background:#4479BA; color: #FFFFFF;" |Personal history
!Medical history
+
! align="center" style="background:#4479BA; color: #FFFFFF;" |Medical history
!Surgical history  
+
! align="center" style="background:#4479BA; color: #FFFFFF;" |Surgical history  
!Family history
+
! align="center" style="background:#4479BA; color: #FFFFFF;" |Family history
 
|-
 
|-
 
|
 
|
 
* History of smoking
 
* History of smoking
* High cholesterol level
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* High [[cholesterol]] level
*  
+
* Sedentery life style
 +
* [[Hyperlipidemia (patient information)|Hyperlipidemia]]
 
|
 
|
* Vasculitis
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* [[Coronary heart disease]]
* Atrial fibrillation
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* [[Cerebrovascular disease]]
* Irregular cardiac rythm disorders
+
* [[Vasculitis]]
* Malignancy
+
* [[Peripheral arterial disease|Peripheral artery disease]]
 +
* [[Irregular heart rhythms|Irregular]] [[Heart|cardiac]] rythm disorders
 +
Such as [[atrial fibrillation]]
 +
* [[Cancer|Malignancy]]
 +
* [[Chronic liver disease]]
 +
* [[Portal vein thrombosis]]
 +
* [[Inflammation|Inflammatory disease]]
 +
* [[Thrombophilia]]
 +
* [[Inflammatory bowel disease]]
 
|
 
|
 +
* Recent [[Abdomen|abdominal]] [[surgery]]
 
|Family history of
 
|Family history of
* Deep venous thrombosis
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* [[Deep vein thrombosis|Deep venous thrombosis]]
* Pulmonary embolism
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* [[Pulmonary embolism]]
|-
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* [[Myeloproliferative neoplasm|Myeloproliferative disorders]]
|
 
|
 
|
 
|
 
|-
 
|
 
|
 
|
 
|
 
 
|}
 
|}
  
 
==Symptoms==
 
==Symptoms==
The severity and rapidity of mesenteric vessels occlusion determine the symptoms of mesenteric ischemia. <ref name="pmid15159262">{{cite journal |author=Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD |title=Acute mesenteric ischemia: a clinical review |journal=Arch. Intern. Med. |volume=164 |issue=10 |pages=1054-62 |year=2004 |pmid=15159262 | doi=10.1001/archinte.164.10.1054}}</ref><ref name="pmid2691119">{{cite journal |author=Font VE, Hermann RE, Longworth DL |title=Chronic mesenteric venous thrombosis: difficult diagnosis and therapy |journal=Cleveland Clinic journal of medicine |volume=56 |issue=8 |pages=823-8 |year=1989 |pmid=2691119}}</ref>
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* The severity and rapidity of [[Mesentery|mesenteric]] [[Blood vessel|vessels]] [[occlusion]] determine the symptoms of [[mesenteric ischemia]]. <ref name="pmid15159262">{{cite journal |author=Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD |title=Acute mesenteric ischemia: a clinical review |journal=Arch. Intern. Med. |volume=164 |issue=10 |pages=1054-62 |year=2004 |pmid=15159262 | doi=10.1001/archinte.164.10.1054}}</ref><ref name="pmid2691119">{{cite journal |author=Font VE, Hermann RE, Longworth DL |title=Chronic mesenteric venous thrombosis: difficult diagnosis and therapy |journal=Cleveland Clinic journal of medicine |volume=56 |issue=8 |pages=823-8 |year=1989 |pmid=2691119}}</ref><ref name="Bobadilla2013">{{cite journal|last1=Bobadilla|first1=Joseph L.|title=Mesenteric Ischemia|journal=Surgical Clinics of North America|volume=93|issue=4|year=2013|pages=925–940|issn=00396109|doi=10.1016/j.suc.2013.04.002}}</ref>
 
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* Systemic classification of acute and chronic [[mesenteric ischemia]] symptoms is as follows:
Systemic classification of acute and chronic mesenteric ischemia symptoms is as follows:
 
 
 
 
{| class="wikitable"
 
{| class="wikitable"
! colspan="3" |Acute mesentric ischemia
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! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Acute mesenteric ischemia
! colspan="2" |Chronic mesenteric ischemia
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! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Chronic mesenteric ischemia
 
|-
 
|-
!General symptoms  
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! align="center" style="background:#4479BA; color: #FFFFFF;" |General symptoms  
!Gastrointestinal symptoms
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! align="center" style="background:#4479BA; color: #FFFFFF;" |[[Gastrointestinal tract|Gastrointestinal]] symptoms
!Life threatening symptoms
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Life threatening symptoms
!General symptoms
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! align="center" style="background:#4479BA; color: #FFFFFF;" |General symptoms
!Gastrointestinal symptoms
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! align="center" style="background:#4479BA; color: #FFFFFF;" |[[Gastrointestinal tract|Gastrointestinal]] symptoms
 
|-
 
|-
 
|
 
|
* Malaise
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* [[Malaise]]
* Nausea (44%)
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* [[Nausea and vomiting|Nausea]] (44%)
* Fever
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* [[Fever]]
 
* Mental confusion
 
* Mental confusion
 
* [[Heart rate]] > 100 in 33%
 
* [[Heart rate]] > 100 in 33%
 
|
 
|
* '''Abdominal Pain:'''(present in 95% cases)
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* '''[[Abdominal pain|Abdominal]] Pain:'''(present in 95% cases)
Site:
+
 
 +
* Site: Periumbilical. Focal pain in case of bowel necrosis.
 +
 
 +
* Onset: Sudden
  
Onset: Sudden
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* Character: Sharp or colicky
  
Character:
+
* Severity: Moderate to severe
  
Severity: Moderate to severe
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* Timing, duration and frequency:  
 +
**Arterial occlusion: 2-3 hours 
 +
**Venous occlusion: 5 hours to more than 30 days
 +
* Aggravating and relieving factors: No association with meals
 +
'''Other associations:'''
 
* Urgency to bowel movements
 
* Urgency to bowel movements
* Vomiting (35%)
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* [[Nausea and vomiting|Vomiting]] (35%)
* Diarrhea (35%)
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* [[Diarrhea]] (35%)
* Constipation
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* [[Constipation]]
 
* Blood per rectum
 
* Blood per rectum
* Abdominal distention
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* [[Abdominal distension|Abdominal distention]]
* Frequency in bowel movements
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* Increased frequency of bowel movements
 +
|'''Signs of [[shock]]:'''
 +
* [[Palpitation|Palpitations]]
 +
* Low [[blood pressure]]
 +
* [[Altered mental status]]
 +
* [[Dyspnea|Shortness of breath]]
 
|
 
|
 +
* [[Nausea and vomiting|Nausea]]
 +
* [[Bloating]]
 
|
 
|
* Nausea
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* '''[[Abdominal pain|Abdominal]] pain:'''
* Bloating
+
 
|
+
* Site: Poorly localised
 +
 
 +
* Onset: Insidious
 +
 
 +
* Character: Transient episodes of pain.
 +
 
 +
* Severity: Mild
 +
 
 +
* Timing, duration and frequency: Months
 +
 
 +
* Aggravating and relieving factors: Worse after meals.
 +
'''Other associations:'''
 
* Fullness after eating
 
* Fullness after eating
* Worsening abdominal pain
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* Worsening [[Abdomen|abdominal]] pain
 
* Aversion to eating
 
* Aversion to eating
* Unintentional weight loss
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* Unintentional [[Weight loss|weight]] loss
* Diarrhea
+
* [[Diarrhea]]
 
|}
 
|}
 +
 
==References==
 
==References==
  

Latest revision as of 20:01, 19 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

The hallmark of mesenteric ischemia symptoms is 'abdominal pain out of proportion to the examination findings'. A positive history of chronic cardiovascular disorder, old age and abdominal pain is suggestive of mesenteric ischemia, unless proven otherwise. The most common symptoms of mesenteric ischemia include excruciating abdominal pain, bloody diarrhea, and nausea/vomiting. Symptoms of chronic mesenteric ischemia caused by atherosclerosis include abdominal pain after eating and diarrhea, while that of acute mesenteric ischemia due to an embolus include diarrhea, sudden severe abdominal pain, and vomiting.

History

Patients suffering from mesenteric ischemia may have a positive history of:[1][2]

Personal history Medical history Surgical history Family history

Such as atrial fibrillation

Family history of

Symptoms

Acute mesenteric ischemia Chronic mesenteric ischemia
General symptoms Gastrointestinal symptoms Life threatening symptoms General symptoms Gastrointestinal symptoms
  • Site: Periumbilical. Focal pain in case of bowel necrosis.
  • Onset: Sudden
  • Character: Sharp or colicky
  • Severity: Moderate to severe
  • Timing, duration and frequency:
    • Arterial occlusion: 2-3 hours
    • Venous occlusion: 5 hours to more than 30 days
  • Aggravating and relieving factors: No association with meals

Other associations:

Signs of shock:
  • Site: Poorly localised
  • Onset: Insidious
  • Character: Transient episodes of pain.
  • Severity: Mild
  • Timing, duration and frequency: Months
  • Aggravating and relieving factors: Worse after meals.

Other associations:

References

  1. Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ (2012). "The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds.". Am J Med. 125 (4): 394–8. PMID 22305578. doi:10.1016/j.amjmed.2011.09.013. 
  2. Sreenarasimhaiah J (2005). "Chronic mesenteric ischemia.". Best Pract Res Clin Gastroenterol. 19 (2): 283–95. PMID 15833694. doi:10.1016/j.bpg.2004.11.002. 
  3. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004). "Acute mesenteric ischemia: a clinical review". Arch. Intern. Med. 164 (10): 1054–62. PMID 15159262. doi:10.1001/archinte.164.10.1054. 
  4. Font VE, Hermann RE, Longworth DL (1989). "Chronic mesenteric venous thrombosis: difficult diagnosis and therapy". Cleveland Clinic journal of medicine. 56 (8): 823–8. PMID 2691119. 
  5. Bobadilla, Joseph L. (2013). "Mesenteric Ischemia". Surgical Clinics of North America. 93 (4): 925–940. ISSN 0039-6109. doi:10.1016/j.suc.2013.04.002. 

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