Doença intestinal isquêmica
Summary
Definition
A doença intestinal isquêmica engloba um grupo heterogêneo de distúrbios causados por processos agudos ou crônicos, decorrentes de etiologias oclusivas ou não oclusivas, que resultam na diminuição do fluxo sanguíneo para o trato gastrointestinal. A evolução clínica pode variar de transitória e reversível a fulminante.
[Figure caption and citation for the preceding image starts]: Histopatologia da isquemia intestinalDo acervo da Dra. Jennifer Holder-Murray; usado com permissão [Citation ends].
History and exam
Key diagnostic factors
- dor abdominal
- desconforto abdominal
- presença de fatores de risco
Other diagnostic factors
- hematoquezia/melena
- diarreia
- náuseas
- perda de peso
- sopro abdominal
- vasculite
- tontura, palidez, dispneia
- fobia alimentar (sitofobia)
Risk factors
- idade avançada
- história de tabagismo
- estados hipercoaguláveis
- fibrilação atrial
- infarto do miocárdio
- defeitos estruturais do coração
- história de vasculite
- cirurgia cardiovascular recente
- choque
- insuficiência cardíaca congestiva
- aterosclerose
- síndrome do intestino irritável
- carcinoma colônico
- constipação
- uso prolongado de laxantes
- uso de vasopressores, digoxina, cocaína
Diagnostic tests
1st tests to order
- tomografia computadorizada (TC) com contraste/angiotomografia
- Hemograma completo
- gasometria arterial e lactato sérico
- ureia e eletrólitos
- testes da função hepática
- proteína C-reativa
- estudos da coagulação, tipagem e reserva de sangue e prova cruzada
- eletrocardiograma (ECG)
- radiografia torácica ortostática
- sigmoidoscopia ou colonoscopia
- endoscopia digestiva alta
- dímero D
Tests to consider
- angiografia mesentérica
- ultrassonografia duplex mesentérica
- angiografia por ressonância magnética
- amilase
- estudos para ovos, cistos e parasitas
- cultura fecal
- Ensaio para toxina de Clostridium difficile
- radiografias abdominais
Treatment algorithm
evidências de infarto, perfuração ou peritonite na tomografia computadorizada diagnóstica
nenhuma evidência de infarto, perfuração ou peritonite na tomografia computadorizada diagnóstica
isquemia mesentérica crônica
colite isquêmica
isquemia colônica não aguda
Contributors
Expert advisers
Jennifer Straatman
Consultant Upper GI surgeon
Queen Alexandra Hospital
Portsmouth
UK
Disclosures
JS declares that she has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Alex von Roon, MB, ChB, PhD, FRCS
Clinical Senior Lecturer
Honorary Consultant Colorectal Surgeon
Department of Surgery and Cancer
Imperial College London
London
UK
James Lewis, MBBS, BSc, MRCS
Clinical Research Fellow
Department of Surgery and Cancer
Imperial College London
London
UK
John Abercrombie FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Disclosures
AVR and JL declare that they have no competing interests. JA is a member of the Council of The Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time. JA provides expert advice regarding suitability of surgical treatments for Spire Healthcare.
Peer reviewers
Frances Howse, MA (Oxon), BM (Hons), FRCS (Eng)
Consultant
Acute and General Surgery
University Hospital Southampton NHS Foundation Trust
Southampton
UK
Disclosures
FH declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Bala M, Catena F, Kashuk J, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022 Oct 19;17(1):54.Full text Abstract
Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016 Apr;42(2):253-70.Full text Abstract
Terlouw LG, Moelker A, Abrahamsen J, et al. European guidelines on chronic mesenteric ischaemia: joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. United European Gastroenterol J. 2020 May;8(4):371-95.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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