Title Akutna mezenterijalna ishemija Title (english) Acute mesenteric ischemia Author Matej Penava Mentor Petar Matošević (mentor)Committee member Predrag Pavić (predsjednik povjerenstva)Committee member Anko Antabak (član povjerenstva)Committee member Petar Matošević (član povjerenstva)Granter University of Zagreb Defense date and country 2024-10-29, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Akutna mezenterijalna ishemija (AMI) je hitno medicinsko stanje, karakterizirano brzom progresijom te visokim mortalitetom. U podlozi AMI-ja nalazi se naglo smanjenje mezenterijalnog krvnog protoka koje, ovisno o trajanju, može uzrokovati transmuralnu nekrozu crijevne stijenke. Etiološki, AMI dijelimo na okluzivne mezenterijalne ishemije (OMI) i neokluzivne mezenterijalne ishemije (NOMI). Od tri česta uzroka OMI-ja, najčešći je embolija mezenterične arterije (EMA), potom tromboza mezenterične arterije (TMA) te mezenterična venska tromboza (MVT). NOMI se prvenstveno javlja kod teških kardiovaskularnih pacijenata u jedinicama intenzivnog liječenja (JIL). Najčešće zahvaćena krvna žila je gornja mezenterična arterija (GMA), i to u više od 85% slučajeva. Zbog velike prilagodljivosti crijeva na smanjeni protok krvi i brojnih kolaterala, tek stenoza gornje mezenterične arterije viša od 90 % ili stenoza preko 70% lumena dvije mezenterične žile uzrokovati će AMI. S prevalencijom od oko 0.1% te incidencijom 5.3–8.4 na 100000 stanovnika godišnje, AMI je rijetki uzrok akutnog abdomena. Incidencija raste i do 10 puta u pacijenata starijih od 75 godina. Ovisno o težini ishemije, može biti zahvaćena samo mukoza, a može napredovati i sve do zahvaćenosti pune debljine stijenke i transmuralne nekroze. Klinička slika AMI-ja je vrlo nespecifična, uključuje intenzivnu difuznu abdominalnu bol, povraćanje, proljev te ostale simptome ovisno o podražaju peritoneuma. Laboratorijski biomarkeri nemaju veliku ulogu u dijagnostici AMI-ja. Zlatni standard u dijagnostici je kompjuterizirana tomografija (CT) angiografija. AMI je dijagnoza koja se prvenstveno liječi kirurški. Otvoreno i endovaskularno liječenje modaliteti su liječenja, svaki sa svojim nedostacima i prednostima. Nova tehnika liječenja – retrogradna otvorena mezenterična ugradnja stenta, kao kombinacija obaju modaliteta, pruža obečavajuće rezultate. Medikamentno liječenje antikoagulansima ima ulogu u postoperativnom liječenju te kao primarna metoda liječenja u slučaju MVT-a. Unatoč napredcima u dijagnostici i liječenju, AMI ostaje entitet koji se često dijagnosticira tek na obdukciji, a glavni prognostički čimbenik je upravo vrijeme potrebno do dijagnoze.
Abstract (english) Acute mesenteric ischemia (AMI) is an emergency condition, characterized by fast progression and a high mortality rate. The underlying cause of AMI is a sudden decrease in mesenterial blood flow, which can cause transmural necrosis, depending on the duration. Etiologically, AMI is divided into occlusive (OMI) and nonocclusive (NOMI). Of the three common OMI causes, the most common is embolism of the mesenteric artery (EMA), followed by thrombosis of the mesenteric artery (TMA) and mesenteric vein thrombosis (MVT). NOMI is primarily found in Intensive care units (ICU) in patients with severe cardiovascular disease. The most affected mesenteric vessel is the superior mesenteric artery (SMA), in more than 85% of cases. Due to the high adaptability of the bowel to decreased blood flow as well as many collaterals, a stenosis greater than 90% of 1 vessel or greater than 70% of 2 mesenteric vessels is needed for AMI to occur. With a prevalence of around 0.1% and an incidence of 5.3-8.4 at 100000 population per year, AMI is a rare cause of acute abdomen. However, the incidence increases tenfold in patients over the age of 75. Depending on the depth of ischemia, only the mucosa can be affected, all the way to full bowel wall thickness and transmural necrosis. Symptoms of AMI are very non-specific and include intense diffuse abdominal pain, vomiting, diarrhea as well as other symptoms depending on peritoneum involvement. Laboratory biomarkers do not have a major role in diagnosing AMI. The gold standard in AMI diagnostics is computed tomography (CT) angiography. AMI is primarily treated surgically. Open and endovascular treatment are treatment options, each with its pros and cons. Retrograde open mesenteric stenting (ROMS) is a new treatment option, combining both treatment options, with promising results. Medication treatment with anticoagulants is used in postoperative treatment as well as the primary treatment option in MVT. Despite the advances in diagnostics and treatment, AMI remains a clinical entity that is still often diagnosed at an autopsy, with the main prognostic factor being time to diagnosis.
Keywords
akutna mezenterijalna ishemija
transmuralna nekroza
embolija mezenterične arterije
gornja mezenterična arterija
endovaskularno liječenje
Keywords (english)
acute mesenteric ischemia
transmural necrosis
mesenteric artery embolism
superior mesenteric artery
endovascular treatment
Language croatian URN:NBN urn:nbn:hr:105:131995 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-10-25 11:19:57
