The blood supply of the intestines of our body at the expense mesaraic (mesenteric) arteries. These arteries move away from the aorta at different levels. There are only two - the upper, part of the so-called celiac trunk and the lower one extending from the aorta itself.
When these arteries by blood flow is disturbed (due to various reasons), there is ischemia of the intestine. Mesenteric ischemia usually affects the small intestine, large intestine less.
The cause of ischemia is a narrowing or blockage of the mesenteric arteries. Most often, mesenteric ischemia suffer elderly and senile patients. According to their flow mesenteric ischemia is an acute, when its symptoms occur abruptly, and chronic when symptoms of ischemia of the small intestine occur gradually and periodically.
What are the causes of mesenteric ischemia?
The most common cause of acute mesenteric ischemia is sudden blockage of an artery of the intestine. This occurs when a state of heart, as atrial fibrillation. Atrial fibrillation - a type of cardiac arrhythmias, kotoryts found in stenosis (narrowing) of the mitral valve. With this type of arrhythmia of the heart wall is very quickly reduced, which leads to the development of the cavity of the heart clots. These clots continue to fall into the aorta, from where they entered into the mesenteric artery. At the same symptoms depend on the size of blood clots, and on the caliber of the branches of mesenteric artery in which a blockage.
Sudden blockage of the arteries supplying the intestines, leading to rapid necrosis of its walls. This leads to the development of severe pain in the abdomen and the appearance of peritonitis - severe complications.
What are the symptoms of mesenteric ischemia?
In chronic mesenteric ischemia may occur abdominal pain 15-60 minutes after eating. Pain can occur in any part of the abdomen, but more often in the middle and upper part of it. Abdominal pain of chronic mesenteric ischemia can last up to six hours, then gradually goes away. Pain reappears after each meal. Thus, patients with chronic mesenteric ischemia often lose weight, because even when hungry, they suffer, trying to avoid a recurrence of abdominal pain.
Occurrence of abdominal pain for chronic mesenteric ischemia due to a mechanism similar to the mechanism of pain in angina and is associated with atherosclerotic lesions of arteries. After the meal there hypercatharsis. However, because the blood supply to the intestine is violated because of the narrow artery atheromatous plaques, there is pain.
Sometimes symptoms of mesenteric ischemia may be unclear, blurred. In addition to abdominal pain and weight loss, it is characterized by the following symptoms:
Diarrhea
Nausea
Vomiting
Inflation
Constipation
Acute ischemia is manifested sudden severe pain in the abdomen. This pain is sometimes not even removed narcotic analgesics. Additionally, there may be nausea and vomiting.
Thus, the main reasons leading to the emergence of mesenteric ischemia are
Atherosclerosis
Thromboembolism
As already mentioned, atherosclerosis in the arteries are formed plaques that narrow their lumen. This in turn vdet deterioration of blood flow. Atherosclerosis is the cause of chronic mesenteric ischemia.
Cause of acute mesenteric ischaemia is often thrombus embolism. These clots are recorded in mesenteric blood flow from the heart.
There are other causes of mesenteric ischemia:
Low blood pressure
Congestive heart failure
Stratification of aortic aneurysm
Disorders of blood clotting
Keep in mind that mesenteric ischemia - a medical emergency. When untimely medical attention for possible severe complications, which lead to the removal of part of the intestine.
Diagnosis of mesenteric ischemia
At the beginning of the doctor asks the patient about the complaints, their nature, timing and duration of occurrence. Conducted a full examination, including tools and methods of diagnosis. These methods include:
Angiography (in this case arteriograiya) - a method of choice, especially in situations of acute mesenteric ischemia with when you need quick diagnosis. This method consists in the fact that the femoral artery through access in the groin folds catheter. The catheter tip is brought above the level of origin of the mesenteric artery from the aorta. The entire process is monitored in real time on a monitor. Then the catheter is introduced radiopaque substance. Then made a series of x-rays. Angiography can also immediately after the results of the study to begin treatment.
Doppler ultrasound. This method allows to determine the velocity of blood flow, but also shows the structure of arteries, narrowing their place or blockage.
Analysis of blood. Typically, acute mesenteric ischemia in the blood was elevated white blood cell count - blood cells that signal the presence of inflammation in the body.
Computed tomography - a method to visualize the abdominal cavity in layers. This method reveals, in particular, the separation of an aortic aneurysm. Magnetic resonance angiography - a method allows to obtain three-dimensional images of the affected vessels and organs in layers. However, its use is limited by the presence of implanted artificial cardiac pacemakers or metallic implants.
Treatment of mesenteric ischemia
The main goal of treatment mesenteric ischemia - a speedy restoration of normal blood flow in the intestine. Depending on the type of ischemia - acute or chronic, treatment may be in an emergency, and in a planned manner.
One method of treatment of chronic mesenteric ischemia is transaortalnaya endarterectomy. In this case the surgeon opens the abdomen to access the aorta and mezeneterialnym vessels. After that the CEA - removal of atheromatous plaques in the inner walls of arteries. Another modern method of treatment of chronic mesenteric ischemia is bypass surgery. It lies in the fact that the surgeon sets the bypass restricted sites mesenteric artery shunt. As the shunt is normally used subcutaneously Vienna hip patient or a synthetic tube. After the shunt blood flow in diseased arteries is restored.
Today the most modern methods of restoring impaired blood flow through blood vessels are angioplasty and stenting. Angioplasty is the summing up to the place of narrowing arteries special catheter with inflated balloon on the end. When the tip of the catheter is in place narrowing, balloon is inflated and the artery expands. This procedure may be supplemented by stenting. Under the stent in place setting means narrowing the artery stent - a cylindrical wire structure, which serves as a scaffold for the artery walls and prevents her from further narrowed.
Treatment of acute mesenteric ischemia - an emergency, since the belated treatment of developing bowel necrosis and peritonitis. For the treatment of acute mesenteric ischemia are used thrombolytic drugs that dissolve clots. These drugs are introduced through the catheter angiography. However, this method is not efficient, in addition, there are contraindications to him: the presence of fresh bleeding gastric ulcers and 12 duodenal ulcer, recent intracerebral hemorrhage, and others. In case of danger of necrosis of the intestine to be removed by a doctor thrombi surgically.
It should be said that the treatment of mesenteric ischemia is dependent on many factors, such as the effectiveness of a method, the risk of complications and duration of treatment.
