Ischemic Bowel

Definition/Etiology:

• Definition
  • (Ischemic Bowel leads to infected bowel. Time is tissue)
  • Ischemia = 75% reduction in intestinal blood flow for more than 12 hours.
  • Infarction = dead tissue
  • The sooner ischemic bowel disease is treated, the more favorable the outcome.
• Etiology – Insufficient blood flow
  • Arterial embolism or thrombosis
    • Atherosclerosis
    • Afib – not as common as CVA, but possible
  • Mechanical Occlusion
    • Trauma
      • Including Direct colon surgery or laparoscopic surgery, too
  • Non Occlusive Ischemia
    • Hypovolemia

Pathophysiology:

• Pathophysiology
  • Intestines supplied by 3 arteries
    • Superior and inferior messetaries
    • celiac artery = collateral supply
  • Mesenteric Vessels are uniquely reactive to several intrinsic and extrinsic factors affecting blood flow.
  • Ischemic Attack
    • Mucosal sloughing
      • Tissue in contact with gut contents
      • SEPSIS
    • Ulceration begins
      • Breakdown of epithelium
    • hemorrhage can occur within 3 hours

Noticing: Assessment & Recognizing Cues:

• Subjective – Rapid Onset
  • Weak
  • Abdominal Cramping & pain
  • Nausea & Vomiting
  • Frequent urge to defecate
• Objective
  • Vitals
    • ↓ BP, ↑ fever
  • Abdomen: Ischemia vs Infarct
    • Distended (Early)/Rigidity(Late)
    • Diminished (Early)/Absent bowel sounds (Late)

Interpreting: Analyzing & Planning:

• Labs
  • CBC (WBC) – Infection
  • Increased Amylase – acute bowel inflammation
  • Increased Lactate – Sepsis
• Diagnostics
  • Abdominal X Ray/CT – obstruction/ assess for free air
  • Abd US – arterial occlusion
  • Radiographic Angiography – Blood supply to in the mesenteries to the intestines

Responding: Patient Interventions & Taking Action:

• Pharmacological Interventions
  • Anticoagulation – Thrombosis
  • Volume replacement – Shocky
  • Antibiotics – Infection
• Non-Pharmacological Interventions
  • NG tube – gastric decompression
  • Angiogram – open occluded vessel = Perfusion
    • 2nd Option is TPA within 8 hours of symptoms
      • Hemorrhage watch
  • SURGERY – bowel resection
    • May wake up with colostomy

Reflecting: Evaluating Patient Outcomes:

• Anticoagulation or embolic lysis for thrombosis-related ischemia
  • Complication = hemorrhage
• Restore fluid and electrolyte balance
  • Septic Shock. Bowels are DIRTY!
  • Urine output = #1 sign of organ perfusion
• Pain Management
  • Ischemia = PAIN
  • Not too much = slows the bowels
  • Find the sweet spot!

Linchpins (Key Points):

• Notice
  • Rapid Acute abdominal symptoms.
  • Early vs late
• Interpret
  • Labs & Diagnostics
    • Help find cause
    • Angiography – fix problem right there!
• Respond
  • Pharmacology = Etiology. Expect IV Abx
• Reflect
  • Restore Perfusion or Colostomy