Shayee Kalyee Shanjeev, PB (2020) Prospective study on Various Factors (Demographic, Clinical, Biochemical) in Patients with Acute Mesenteric Ischemia. Masters thesis, Madras Medical College, Chennai.
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Abstract
AIMS AND OBJECTIVES: To analyse various demographic, clinical and biochemical factors in patents diagnosed with acute mesenteric ischemia, so these factors may help in diagnosing acute mesenteric ischemia in patients coming with acute abdominal pain in emergency settings in the absence of imaging modality MATERIALS AND METHODS: This is a prospective study conducted in Madras Medical College from January 2018 to May 2019. 30 patients in whom acute mesenteric ischemia was identified by explorative laparotomy or CECT angiogram or mesenteric angiogram were included in this study. The parameters observed in these patients were age, sex, Previous history of thrombotic disease and atrial fibrillation, body temperature, signs of peritonitis, WBC counts, Platelet counts, Mean platelet volume, red cell distribution width, Serum amylase, D-dimer and Metabolic acidosis. RESULTS: In this study the majority of patients were in the 61-65 years group whereas the Least represented group were aged less than 55 years. There is no known gender predilection, but in this study the majority of the patients were male (63%). 37% of study subjects gave a positive history of thromboembolic events or atrial fibrillation. In early stages temperature alterations may not be present. Only 40% of patients were febrile at presentation. Clinical signs of peritonitis developed when the ischemia became transmural which was observed in 47% of the patients. WBC Counts more than 11000/mm3 and less than 4000/mm3 occur in late stages of bowel gangrene when SIRS developed. Abnormal counts can also occur even in mucosal ischemia which were observed in 96.7% of sample patients. Normal platelet counts were observed in 87% of patients. Low platelet levels are expected once patient develops disseminated intravascular coagulation and hence are associated with poor prognosis. Increased MPV was found to be an independent predictor factor of mortality in ischemic vascular events. Elevated MPV was noted in 77% of study patients. Increased RDW at admission was a predictor of the extent of necrosis and mortality in AMI patient. Elevated RDW was observed in 77% of the patients. Elevated serum amylase was observed in 43.3% of the patients. The magnitude of the hyperamylasaemia appeared to be related to the extent of the bowel infarction. Elevated D-Dimer levels were noted in 96.7% of the patients. They are present in the blood after a blood clot is degraded by fibrinolysis. While a negative result practically rules out thrombosis, a positive result can indicate thrombosis but does not rule out other potential causes. Metabolic acidosis is a component of advanced AMI with bowel gangrene accompanied by systemic sepsis. 43.3% of patients showed metabolic acidosis in biochemical analysis. CONCLUSION Frequency of WBC counts, D-Dimer, Red cell distribution width and Mean platelet volume were found to be significantly elevated in patients with acute mesenteric ischemia. The frequency of nonbiochemical parameters in our study such as Demographics (age, sex), Previous history (thrombotic disease, atrial fibrillation) and Clinical signs (body temperature, signs of peritonitis) were found to be low in AMI indicating that cannot be relied in making or excluding the diagnosis. Multiple studies have been previously done analysing the various biochemical parameters and their role in disease process and how they can be exploited for use in regular clinical practise to diagnose and identify the prognosis of AMI.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711016 |
| Uncontrolled Keywords: | Demographic, Clinical, Biochemical, Acute Mesenteric Ischemia, Prospective study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 00:36 |
| Last Modified: | 09 Feb 2021 00:36 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13933 |
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