mesenteric vascular ischemic disease
Introduction
Introduction to mesenteric vascular ischemic disease Mesenteric vascular ischemic disease is a general term for a group of diseases. It is a syndrome of intestinal ischemia and necrosis and intestinal motility dysfunction caused by various causes of acute or chronic intestinal perfusion and reflux obstruction. Intestinal wall ischemia caused by abnormal blood circulation, mesenteric vascular disease and other systemic or local diseases can cause this disease. This disease can affect the entire digestive tract. However, the left colon is more common. Especially the colon spleen is more common. This is because each time the spleen of the colon is supplied by the anastomosis of the superior and inferior mesenteric artery, the ability to fight ischemia is the weakest, and it is prone to insufficient blood supply. It is not uncommon for such diseases to age with the population. Among them, the mesenteric artery, especially the superior mesenteric artery, is more than the mesenteric vein. Due to acute blood circulation disorder of mesenteric vessels, intestinal necrosis of the intestine is clinically manifested as bloody intestinal obstruction. Early diagnosis and early treatment, including supportive therapy and surgical treatment. basic knowledge The proportion of illness: 0.004%-0.007% Susceptible people: no specific people Mode of infection: non-infectious Complications: diarrhea, nausea and vomiting, abdominal pain
Cause
Causes of mesenteric vascular ischemic disease
Superior mesenteric artery embolization (35%):
Embolism of the superior mesenteric artery, the embolus is mostly from the heart, such as wall plug after myocardial infarction, valvular heart disease, atrial fibrillation, endocarditis and so on. It can also come from atheromatous plaques on the aortic wall; embolization can occur at the exit of the superior mesenteric artery, more often in the narrower distal part, and the common site is below the exit of the middle colonic artery.
Superior mesenteric artery thrombosis (26%):
The superior mesenteric artery thrombosis occurs mostly on the basis of arteriosclerotic obstruction or stenosis, often involving the entire superior mesenteric artery. There are also more limited.
Superior mesenteric vein thrombosis (25%):
Superior mesenteric vein thrombosis can be secondary to abdominal infection, cirrhosis, portal vein hypertension, blood stasis, polycythemia vera, hypercoagulable state and trauma or surgical vascular injury.
Prevention
Mesenteric vascular ischemic disease prevention
Eat a blood vessel "scavenger". Hawthorn, oatmeal, black fungus, kumquat, eggplant, sweet potato, garlic, and onion are the eight foods that can dredge blood vessels and maintain the elasticity of the blood vessel wall. Vinegar also softens blood vessels and lowers blood fat. Of course, the most important thing is to adhere to a balanced diet, eat more fruits and vegetables, and be alert to the "four high" food.
Continuous exercise is not lazy. British studies have found that long-term, sustained exercise can significantly improve vascular function in patients with cardiovascular disease and even prevent recurrence of myocardial infarction. Many cardiovascular and cerebrovascular experts are masters of persistence in exercise. For example, Professor Hu Dayi insisted on Days of the World for 12 years, and it is also uninterrupted in the Ali Plateau area of Tibet. Jogging, brisk walking and other tempering exercises are suitable for most patients.
Complication
Mesenteric vascular ischemic disease complications Complications, diarrhea, nausea and vomiting, abdominal pain
Intestinal wall ischemia caused by abnormal blood circulation, mesenteric vascular disease and other systemic or local diseases can cause this disease. Can affect the entire digestive tract. However, the left colon is more common. Especially the colon spleen is more common. This is because the spleen of the colon is supplied by the anastomosis of the superior and inferior mesenteric arteries, and the ability to resist ischemia is the weakest, and it is prone to insufficient blood supply.
Symptom
Symptoms of mesenteric vascular ischemic disease Common symptoms Abdominal pain Colonic obstruction Nausea and vomiting Abdominal tenderness Abdominal tension diarrhea
According to the nature, location, extent and occurrence of mesenteric vascular occlusion, clinical manifestations vary. Generally, the more urgent the process of blockage occurs, the wider the range. The more serious the performance. The condition of arterial occlusion is more acute and severe than venous obstruction. The clinical manifestations of superior mesenteric artery embolization and thrombosis are similar. The general onset of sudden onset, early manifestations of sudden severe abdominal cramps, frequent nausea and vomiting, diarrhea. The abdomen is flat and soft, with mild tenderness and active or normal bowel sounds. It is characterized by severe symptoms that are not commensurate with minor signs. The whole body changes are not obvious, but if the vascular occlusion is extensive, shock can occur earlier. With the development of intestinal necrosis and peritonitis, the abdominal distension is becoming more and more obvious, the bowel sounds disappear, and abdominal periplasmic irritation such as abdominal tenderness and abdominal muscle tension appear. Vomiting dark red bloody fluid, or bloody stools, abdominal puncture fluid is also bloody. The blood picture shows more blood concentration, and the white blood cell count can be significantly increased in the early stage of the disease, often reaching more than 20×10 9 L.
Patients with superior mesenteric artery thrombosis often have signs of chronic superior mesenteric ischemia. It is manifested as abdominal pain after a full meal, so that the patient does not dare to eat and gradually lose weight, and accompanied by symptoms of intestinal malabsorption such as chronic diarrhea. When thrombosis suddenly causes acute complete vascular occlusion, it appears to be similar to superior mesenteric artery embolization. The symptoms of superior mesenteric vein thrombosis develop slowly, and there are many prodromal symptoms such as abdominal discomfort, constipation or diarrhea. Sudden severe abdominal pain and persistent vomiting after several days to several weeks, but hematemesis and blood in the stool are more common, abdominal distension and abdominal tenderness. The bowel sounds are reduced. Abdominal puncture can draw hemorrhagic fluid, often with fever and increased white blood cell count.
Examine
Examination of mesenteric vascular ischemic disease
Usually blood tests do not help in the diagnosis of superior mesenteric venous thrombosis. Metabolic acidosis and elevated serum lactate levels can be used to determine the presence of intestinal necrosis, but often in the late stages of the disease. 50% to 75% of patients had normal abdominal plain film examination, and only 5% of patients showed special signs of intestinal ischemia: finger pressure in the intestine showed intestinal mucosal ischemia, intestinal wall emphysema or portal vein free gas was mesenteric vein. A characteristic manifestation of intestinal infarction caused by thrombosis. Mesenteric venous thrombosis can be found by abdominal color Doppler ultrasonography, but computed tomography (CT) should be used for cases suspected of having mesenteric venous thrombosis.
CT examination can make a diagnosis of 90% of patients, but the accuracy of diagnosis of small thrombus in the early portal vein is reduced. Selective mesenteric angiography can show thrombosis in large veins or delayed development of the superior mesenteric vein. Magnetic resonance imaging has high sensitivity and specificity for the diagnosis of superior mesenteric vein thrombosis, but its examination process is more complicated and poorly popular. With advances in technology, magnetic resonance imaging may have a place in the diagnosis of superior mesenteric venous thrombosis.
Patients with mesenteric venous thrombosis may have serous blood ascites, and diagnostic abdominal puncture may be helpful in diagnosis. Pneumoperitoneum in laparoscopic surgery may increase intra-abdominal pressure and reduce mesenteric blood flow and should be avoided. Fiber colonoscopy and gastroduodenal endoscopy are of limited value because the colon and duodenum are rarely involved. Endoscopic ultrasonography can detect mesenteric venous thrombosis, but it is best for patients with no acute symptoms because of the dilatation of the intestine during the examination.
Diagnosis
Diagnosis and diagnosis of mesenteric vascular ischemic diseases
diagnosis
The diagnosis of this disease mainly depends on the history and clinical manifestations. Abdominal x-ray plain film shows mild or moderate dilatation of the affected small intestine and colon. In the late stage, due to a large amount of fluid in the intestinal cavity and abdominal cavity, the plain film shows an increase in the general density of the abdomen. Selective angiography is important for diagnosis.
Differential diagnosis
Early can help identify vascular embolism, thrombosis or spasm, and can also be treated with vasodilators.
