tarmischemi

Tarmischemi, commonly referred to in English as intestinal ischemia, is a condition in which the blood supply to the intestines is reduced or blocked, leading to insufficient oxygen delivery and potential bowel injury. It can affect any part of the gastrointestinal tract and may present acutely or chronically.

The condition is usually categorized into acute mesenteric ischemia and chronic mesenteric ischemia. Acute mesenteric ischemia (AMI) can result from arterial embolism (often from the heart in atrial fibrillation), arterial thrombosis on atherosclerotic vessels, or nonocclusive mesenteric ischemia related to low flow states such as shock or severe sepsis. Mesenteric venous thrombosis is another cause, where blockage of the venous drainage reduces intestinal perfusion. Chronic mesenteric ischemia, typically due to atherosclerotic narrowing of the mesenteric arteries, presents with postprandial abdominal pain and weight loss.

Clinical presentation varies by type. AMI often causes sudden, severe abdominal pain that is out of proportion to a minimally tender or soft abdomen early on, with nausea, vomiting, or gastrointestinal bleeding later. NOMI may occur in critically ill patients and may have subtler signs.

Diagnosis relies on imaging, with CT angiography as the preferred test to identify vascular occlusions or nonocclusive states. Laboratory tests are nonspecific but may show elevated lactate, leukocytosis, or metabolic acidosis.

Treatment focuses on restoration of blood flow and management of complications. Revascularization via endovascular or surgical means is used for arterial occlusions; anticoagulation is standard for mesenteric venous thrombosis. Antibiotics and prompt surgical evaluation are indicated if bowel necrosis or perforation is suspected.

Prognosis depends on the timeliness of diagnosis and intervention, with high mortality in delayed or advanced cases. Prevention targets underlying vascular risk factors and conditions such as atrial fibrillation.