Let us now move in to greater detail about mesenteric ischemia.
This is acute mesenteric ischemia, an absolute emergency.
The patient walks in or he get a clinical vignette and you've been given an ECG.
On your ECG, take a look at your P waves or at least you try to identify them and you can?t.
They are absent or they are wavelike.
And you notice that the heart rate is approximate 250 bits per minute.
Patient here maybe approximate 65 years of age, so elderly.
At this point, you are worried about the left atrium undergoing atrial fibrillation
and with this turbulence that's taking place within left atrium
then this is part of Virchow's triad. Meaning to say, that it is now prone to thrombotic formation.
A thrombosis that is now developing in the left atrium becomes very dangerous,
because you are worried about breaking off the thrombi and embolization destroy.
Now, I will tell you, that the embolization and the most important of embolization
or the most destructive, but not the most common side of embolization.
So, a couple of things here. When we talk about cerebrovascular accident and stroke,
when you have embolization from atrial fibrillation of your thrombi from the left atrium,
what you are worried about and why you are giving this patient prophylactic warfarin,
is so that you will prevent out, to this day clinically it's been proven evidence based,
that warfarin is the drug of choice to prevent cerebrovascular accidents
as a result of embolization of a thrombus in left atrium secondary to atrial fibrillation.
You got all that? Now, in terms of embolization, it is not the carotid artery
in which it is the number one site. It may end up in the renal artery with embolization
or as our topic here brings us to SMA, which stands for super mesenteric artery.
Embolization enter super mesenteric artery acutely, will result in mesenteric ischemia.
Keep in mind that you should be hearing bowel sounds at all times within your abdomen.
And so therefore, when you have ischemia taking place gone as the bowel sound.
This is an emergency, ladies and gentlemen. Therefore, you have to then perform surgery.
The only problem is if you would then resect a large part of the intestine,
then what you have left behind might not be sufficient.
Meaning to say, you have induced or created an environment of short gut syndrome.
And anytime you have a short gut, you worried about malabsorption, malabsorption, malabsorption.
This is acute mesenteric ischemia.
Do not forget about the exact story that I've given you here
that most likely is going to appear in some way shall perform on your boards.
Chronic mesenteric ischemia, we called this ?intestinal angina?.
What is angina mean to you?
In general, angina means that there is increase demand of oxygen by that organ
and which the supply and perfusion is not met. Here we have ?intestinal?.
Associated with vascular disease and diabetes mellitus,
presents with fear of eating and abdominal bruit because of decrease perfusion.