Diagnostics and treatment of patients with visceral ischaemia
Authors:
L. Kubíček; R. Staffa; T. Novotný
Authors‘ workplace:
Přednosta: prof. MUDr. Robert Staffa, Ph. D.
; Centrum cévních onemocnění
; II. chirurgická klinika
; Fakultní nemocnice u sv. Anny v Brně
; Lékařská fakulta
; Masarykova univerzita, Brno
Published in:
Prakt. Lék. 2019; 99(6): 253-257
Category:
Various Specialization
Overview
Visceral ischaemia is a pathological condition characterized by arterial malfunction in splanchnic circulation leading to an ischaemia of organs in abdominal cavity. It is a relatively rare condition, but it’s consequences can be fatal. There are two forms of visceral ischaemia: acute visceral ischaemia, what is a kind of acute abdomen (also called vascular ileus) and chronic visceral ischaemia caused by atherosclerotic lesions of abdominal aorta and splanchnic branches. The most typical sign of both forms of visceral ischaemia is an abdominal pain either severe acute pain with catastrophic course or progressively developing pain accompanied by alimentary disorder and unintentional weight loss. Differential diagnostics in both forms based only on clinical symptoms is usually difficult and can easily lead to a wrong diagnosis and holdup of necessary revascularization procedure. Ultrasound examination has a lower sensitivity and angiographic examination is usually needed to acquire a proper diagnosis. In the case of acute ischaemia patient’s life is immediately threatened due to a high risk of intestinal necroses (with mortality between 60 and 100%), this condition requires urgent surgical intervention in form of thrombectomy or bypass surgery, in most of the cases accompanied with resection of necrotic part of the intestine. The leading symptom in the case of chronic ischemia is abdominal pain after eating and unintentional weight loss. After a proper diagnosis is set, the best course of treatment is an endovascular procedure in form of percutaneous angioplasty or stent implantation. If an atherosclerotic lesion is too severe, surgical bypass or arterial patch should be considered. Both approaches have a comparable outcome regarding a pain relief, surgical methods have a higher rate of complications but also a better long-term patency. Because of a high severity of this conditions we should always consider a possibility of visceral ischaemia in any case of either acute or chronic abdominal pain.
Keywords:
visceral ischaemia – mesenterial ischaemia – abdominal pain diagnostics – intestinal infarction – vascular ileus
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General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2019 Issue 6
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