Understanding Mesenteric Ischaemia

[@asyoz]

Thanks for this! It was really interesting! This is what my Dad died from. He had an embolism of the superior mesenteric artery. (Note, this sentence is also the TL:DR.) Mind you, if anyone ever asks, I usually just simplify it and say he died from Stupidity. Please, allow me to explain... Dad had a stroke, some 35 years earlier, and had been on warfarin since then. About two months before his death, he'd gone to the dentist, who needed to take a tooth out, so he instructed dad to stop taking his warfarin for a week, and come in to get the tooth out, whereupon he should re-start his warfarin. Dad, being the highly-qualified medical professional that he was(not), decided that because he'd been off his warfarin for a week and felt fine, he obviously didn't need it anymore. No amount of begging, cajoling or yelling at him helped. I tried, Mum tried, I even went so far as to call his doctor to let him know that Dad was refusing to take them, and he said "I know, I've told him it's dangerous and it could kill him, but he still doesn't want to do it, what can I do?" Anyway, fast forward to a couple of months after the tooth extraction, Mum and Dad went to a dinner dance (Saturday night). On Sunday morning, he felt unwell. He told Mum that the chicken from the night before must have been bad. Mum said that she'd had it too and was fine. She checked with a few of their friends who'd had the same and they were fine. Monday came, Dad was still feeling sick, Mum tried to get him to go to his doctor, but he knew better, it was "just the chicken". Tuesday came and went, he was still sick. Wednesday morning, Mum got up and was surprised Dad wasn't already up, she went to his room to check on him (sep rooms, his snoring was legendary). He was in bed, in a cold sweat. She called an ambulance (while she had him change pyjamas because the ambulance people couldn't possibly see him in sweaty PJs...). An ambulance came and took him to the hospital. He lay on a gurney in the hall for a few hours, at which point some junior doc saw him and said 'yeah, it's probably just food poisoning, you'll be fine, go home'. To Dad's credit, he said 'No, it's something worse than that, get someone who knows something'. The second doc looked at him and in some form of panic, called the surgery unit. So, that evening, dad went in to surgery. They had to remove some 90% of his intestines. I was horrified. He was a belligerent PITA, there was NO way he'd cope with short-gut syndrome. None. Anyway, that night, he had a fever hanging around 41-42c and went into severe febrile delirium (that was fun...) and decided that Mum had poisoned him, so he was screaming some 'delightful commentary' (to the point that I had Mum removed from the room as she was really running down and not coping with this). So, the surgeon's registrar came in the following morning to check on him. I said, "He's not good, he's been in a horrific fever all night, which was not controlled at all". The registrar recommended taking him back to surgery to have a look, as he suspected there was still necrotic bowel in him. I said that was fine, but, if there was any more bowel that needed to come out they were to just close and leave him medicated to slip away. TBH I was surprised when they said he only had 10% of bowel left, I didn't think that was enough to survive with, but any worse - well, there wasn't any way he'd cope with it. As it was he was going to have to go into an elder-care facility. Mum was terrified he'd want to go home and there was no way she'd be able to look after him as he wouldn't allow her to restrict his food, nor would he agree to be tube-fed. He was an incredibly antagonistic 80yo, had severe PTSD from WW2 and always knew better than everyone else. I had to assure her he was NOT going home under any circumstances, even if he made it out of there (which, by this time, I was fairly sure he wouldn't), he wasn't going home. Anyway, they took him to pre-surgery and recommended we go home, as we lived fairly close to the hospital and it would be some hours before they got him in, never mind getting out and going through post-op. So, we went home, and about 5 hours later, the phone rang. I answered, the voice on the other end introduced himself as the Surgeon. I said, "Oh, shit, that bad, eh?" He said, "What do you mean, I haven't said anything yet?" I said "Yeah, but if it was good news, you would have had the registrar call us to come into the hospital. You'd only ring if it was bad news. Am I wrong?" He said, "No, that's pretty much exactly right." Turns out the rest of dad's bowel had necrotised, and it's not easy to survive with 0% bowel. So they'd opened him, taken one look, and closed. He was on heavy morphine and up in the ICU. We went in and sat with him until he passed. So, upcoming surgeons and doctors. Please feel free to use this as a cautionary tale for any patients who decide they're just fine and can stop taking their warfarin. Feel free to print it out and give it to them. Hopefully, it can save someone else from an incredibly painful and harrowing death (and save their family watching it all happen). *Sorry this was so long...

[@waelfadlallah8939]

Thank you for taking the time to talk about your experience and i hope your message will get to whom it may concern.

[@MohammedAli-jr5lu]

Sorry for what happened to your dad. I appreciate your good intention to help others not to go in this tragedy. By the way my dad had a similar experience but it was the fault of his doctor who stopped his antiarrythmic drug and Ik agree with you it was a horrible experience!

[@plasticvision]

Thank you for sharing this and sorry for your loss. Some learning points here to take on board for us future clinicians

[@ThatsWhy-]

@@waelfadlallah8939 still flying from one account to another! Boy! Stop it

[@asyoz]

@@plasticvision You're welcome, and thank you. I just hope that this can help someone else understand how a: it's important to take the meds you're prescribed, and, b: you don't always see an absolutely immediate reaction to taking or stopping meds, sometimes it takes a while for meds to start working properly, or stop working completely. I honestly hope this will help you help someone.

[@whysoserious8552]

Exactly two weeks ago my mother passed away due to an acute mesenteric ischemia in less than 24 hours, hence the reason why I’m here. Thank you for helping me understand this better.

[@parulsingh1142]

Hy please can you explain unhe kya symptoms the meri mother k liye b bola hai C T scan suspect hai mysenteric ischemia

[@kmc79228]

My mum did last month 😢x

[@vangelisantoninis9065]

This was a great video! Just one thing, I believe it’s worth to mention that d-dimmers are increasing in cases of acute bowel ishaemia. This is crucial in order to differentiate the diagnosis from other diseases namely diverticulitis.

[@chanvalentine8283]

My father died from this after having many years of ulcerative colitis. He believed Doctors were ondly good for setting broken bones, and stopping arterial bleeding...By the time he made it into the ER. He was already underweight and vomiting out the contents of his small bowel. Please try to get your patients to drop their cholesterol, and stop smoking. They don't need to spend their final years/months eating only ice cream, hotdogs, and Ensure. . .If he had gone in sooner, they would have given him a gastric bypass if he had enough flesh on his bones. It is not a 'good' death.

[@waelfadlallah8939]

Great video ! Glad you've mentioned the elevated lactate level in this case it was a very beneficial reminder :)

[@ZeroToFinals]

Glad it was helpful!

[@sarahs4806]

I have mesenteric ischaemia (SMA stenosis) & was mis-diagnosed with IBD, IBS etc & waited almost 7 years to be diagnosed - I was 40. I have a pretty colourful medical history with a heart transplant due to HOCM (hypertrophic cardiomyopathy) & OI (brittle bones) s9 I guess it was expected I'd end up with something like this because of my heart problems. However, please could I stress that I would like to see more doctors testing for this when the pain is unexpected because mine is not 'text book' so I can get the pain if I eat or if I don't. It can wake me, the pain can be either a really bed (like you have been punched in the solar plexus) that lasts up to a full day or more & then there's the pain that sto0s you doing anything. You can't concentrate, you can't have a conversation & no pain relief hel0s. The pain starts in the same place but then the pain engulfs y9ur entire abdomen...your back aches so much. The exhaustion is unbearable but you can't sit down or lie down. It is horrendous. I have been stented & I am waiting to back in for a bypass because we are back to square one. I am on platelet thinners but as yet, have not found any pain relief that is effective. Brilliant video ❤️

[@tenmiltenmil1770]

Thursday December 15th 2022 Thank you for taking the time to make these vital and valuable medical information videos ! You make it so much easier to understand in a matter of minutes ! ❤️❤️❤️👍👍👍⭐️⭐️⭐️⭐️⭐️😊😊😊

[@ZeroToFinals]

Thanks

[@r.y776]

Many many thanks for these informative videos. ❤❤❤

[@loricagardener4826]

I had this last year from a Covid clot. It is very painful and frightening!

[@charlenegoskowicz8220]

My father died from acute mesenteric ischemia, brought on by covid clots in the small blood vessels. Incredibly painful. We knew he'd die without surgery, but we also knew there was a chance of his never waking up if surgery were performed. The poor man was in such pain that he was begging my late mother to come get him. After surgery, he held his own for the first 24 hours, but he was just too sick, and his heart stopped. I send love to all of you who have had to watch a family member suffer from this terrible condition.

[@charlenegoskowicz8220]

I also send love to those of you who have personally experienced this painful illness.

[@Hujuraq-wj3no]

شكراً جزيلاً 🤲🏻 الله يهديك للطريق الصحيح ان شاء الله ❤

[@pravinakolkar7218]

Can you Pl make revised video so that common people to understand and approach to expert bcoz anyone can be victim of thease disease which found due unaware or lack of diagnosis skill of Family doctor, further result in complicated to his family and always to test his /her blood and which is very expensive adjust used medicine dosages too. Thanks for video .Pl consider my request seriously. WAITING FOR reply.

[@sueda3578]

You'll are such geniuses. You literally made me understand key concepts and pass my general surgery osce with ease

[@ZeroToFinals]

Great to hear. Congrats on passing your OSCE!

[@maybe-monii]

شكرا جزيلا شرح موفق ، رعاك الله 😊

[@hmirza2879]

Do we not go for arteriography rather than ct scan?

[@74panamacanal]

Hello, a week ago I had a doppler and the result was that I have mesenteric ischemia. Three days after dr sent me CT scan with contrast and the results came normal.... Why? I am still waiting for my doctor to call me and explain what happened.

[@MSALL-co8bf]

I understand

[@lanky-x782]

I know this is old but may I ask what your doctor said?

[@74panamacanal]

@@lanky-x782 If I recall correctly, the doctor explained that the doppler is a preliminary test that can provide a false positive but unlikely or never a false negative. So, positive results need to be confirmed by the more expensive and resource-intensive CT scan.

[@geetasadera664]

Thank you so much

[@chinglanlie639]

that's knowledge

[@SohailAhmad-os8qu]

♥️

[@mohammadbayazid5064]

👌

[@Aloha-sailor]

FYI, that's not a correct representation of A-fib.