GASTROENTEROLOGY ARTICLE OF THE WEEK
October 7, 2004
Oldenburg WA, Lau LL, Rodenberg TJ, et al. Acute mesenteric ischemia. A clinical review. Arch Intern Med 2004;164:1054-62.
1. Pharmacologic compounds that decrease splanchnic blood flow include
a. dobutamine
b. norepinephrine
c. digoxin
d. phenylephrine
e. low dose dopamine
f. adenosine
2. Conditions that may lead to NOMI (Nonocclusive Mesenteric Ischemia) include
a. hypovolemia
b. cocaine overdose
c. congestive heart failure
d. digoxin
e. papaverine infusion
f. acute myocardial infarction
True or False
3. Mesenteric venous thrombosis is the least common cause of mesenteric ischemia.
4. Arterial emboli are the most frequent cause of AMI, accounting for 40% to 50% of cases.
5. When AMI is caused by arterial thrombosis, the extent of bowel involvement is typical greater than when it occurs secondary to arterial embolism.
6. The majority of the mesenteric blood flow is directed towards the muscularis and serosal layers of the intestine.
7. MRI is superior to mesenteric angiography for the diagnosis of AMI.
8. Most patients with MVT require surgery.
9. Most emboli will lodge distally to the origin of the middle colic artery, a branch of the SMA; thus the proximal jejunum is usually spared.
10. AMI secondary to arterial embolization almost always occurs in the setting of severe atherosclerotic disease.
11. Enteral feedings in a critically ill post-surgical patient with hypotension can trigger NOMI.
12. CT is the test of choice when suspecting AMI secondary to arterial embolism.
13. The management of AMI may include
a. Fluid resuscitation
b. Broad spectrum antibiotics
c. IV glucagons at 1ug/kg/min to help with vasospasm
d. IV papaverine through peripheral IV
e. MRA testing if peritoneal signs are present