Gastro: Acute Mesenteric Ischemia: Free MSRA Podcast

⚕️FREE MSRA PODCAST –Acute Mesenteric Ischaemia (AMI)🎧 Your rapid, high-yield briefing on thislife-threatening vascular emergency. Ideal for mastering MSRA exam revision and clinical recognition. 🧠Key Learning Points 📌Definition• Acute Mesenteric Ischaemia = sudden reduction in blood flow to the smallintestine• Leads to intestinal ischaemia, necrosis, and potentially deathif not treated rapidly📌Causes (The 4 Types –Mnemonics included)🫀 Arterial embolism ("Escaping heart") – e.g. AF, recent MI, prosthetic valves🧱 Arterial thrombosis ("Hard arteries") – e.g. atherosclerosis💔 Non-occlusive (NOMI) ("Fainting heart") – e.g. low cardiac output, shock🩸 Mesenteric venous thrombosis ("Young thick blood") – e.g. hypercoagulable states, malignancy 📌Risk Factors• Age >60• Atrialfibrillation• Atherosclerosis• Heart failure• Hypercoagulableconditions (e.g. cancer, protein C/S deficiency)• Recent cardiac orvascular surgery• Sepsis, low-flowstates (NOMI) 📌Pathophysiology• ↓ Blood flow → hypoxia → cellular injury → necrosis• The extent and durationof ischaemia dictate severity• Late findings =bowel infarction, peritonitis, sepsis 📌Clinical Features⚠️Key phrase: "Pain out of proportion to exam"• Sudden severeabdominal pain• Nausea, vomiting• May appear wellinitially, but rapidly deteriorates• Later signs:peritonitis, sepsis, shock 📌Differentials• AAA rupture• Appendicitis• Cholecystitis• Pancreatitis• Bowel obstruction• Ectopic pregnancy• MI or pneumonia(referred pain)• Chronic mesentericischaemia (post-prandial pain, weight loss) 📌Diagnosis🧪 Bloods:• ↑ Lactate (metabolic acidosis – red flag)• ↑ WCC, ↑ CRP• Clotting,U&Es, LFTs, amylase📸 Imaging:• ✅ CT Angiography – gold standard• AXR/chest X-raymay help rule out perforation• ECG to look for AF• Considerechocardiogram or Doppler 📌Management🚨 Emergency resuscitation:• Oxygen, IV fluids, antibiotics, anticoagulation(heparin)• NG tubedecompression🩺Surgery (laparotomy) for infarcted bowel• Embolectomy /revascularisation• Resection ofnon-viable bowel🧬 In select cases: endovascular thrombolysis orangioplasty 📌Prognosis• Mortality 50–90% – highest of all abdominalemergencies• Prognosis worsenswith delayed diagnosis or extensive bowel loss• Survivors may faceshort gut syndrome, lifelong parenteralnutrition 📌Complications• Bowel infarction, perforation, peritonitis• Sepsis, multi-organfailure• Short gut syndrome 📎More MSRA Resourcesfor Acute Mesenteric Ischaemia📝 Revision Notes: https://www.passthemsra.com/topic/acute-mesenteric-ischaemia-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/acute-mesenteric-ischaemia-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/acute-and-chronic-mesenteric-ischaemia-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/acute-mesenteric-ischaemia-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA #MSRARevision#MSRAGastroenterology #AcuteMesentericIschaemia #MSRAFlashcards #MSRAQandANotes#PassTheMSRA #FreeMSRA #MSRAQuiz #MSRAOnlineRevision #CTAngiogram#PainOutOfProportion