[2] Chronic Mesenteric Ischaemia Flashcards
What is chronic mesenteric ischaemia?
A lack of blood supply to the bowel which gradually deteriorates over time as a result of atherosclerosis in the coeliac trunk, superior mesenteric artery, and/or inferior mesenteric artery
What is the pathophysiology of the development of chronic mesenteric ischaemia?
The gradual buildup of atherosclerotic plaque causes the narrowing of the blood vessel lumen, reducing blood flow and resulting in ischaemia of the bowel
What is the result of the degree of communication within the visceral blood supply in chronic mesenteric ischaemia?
In the majority of circumstances, at least 2 of the CT, SMA, and IMA must be affected
What causes symptom onset in chronic mesenteric ischaemia?
When there is increased demand on the blood supply or reduction in blood supply in patients with chronic mesenteric ischaemia a transient ischaemia of the bowel occurs, resulting in symptom onset
What can cause an increased demand on the blood supply to the gut?
Eating
What can cause a reduction in blood supply to the gut?
Hypovolaemic states
Who does chronic mesenteric ischaemia mostly occur in?
Patients >60 yrs
Which gender does chronic mesenteric ischaemia more commonly occur in?
Females
Why is chronic mesenteric ischaemia typically under-reported?
Because patients with atherosclerotic disease in the mesenteric vessels are often asymptomatic
What is the prevalence of atherosclerotic involvement in the mesenteric vessels?
Between 30-50%
What are the main risk factors for chronic mesenteric ischaemia?
- Smoking
- Hypertension
- Diabetes mellitus
- Hypercholesterolaemia
What are the classical symptoms of chronic mesenteric ischaemia?
- Post-prandial pain
- Weight loss
When does postprandial pain occur in chronic mesenteric ischaemia?
Typically around 10mins - 4 hours after eating
What may postprandial pain be associated with?
Fear of eating (sitophobia), as eating becomes linked to pain
Why can chronic mesenteric ischaemia lead to weight loss?
A combination of decreased calorie intake and malabsorption
What concurrent vascular co-morbidites may be present with chronic mesenteric ischaemia?
- Previous MI
- Previous stroke
- PVD
What are the less specific symptoms of chronic mesenteric ischaemia?
- Change in bowel habit (typically loose)
- Nausea
- Vomiting
What are the examination findings in chronic mesenteric ischaemia?
Often non-specific, including;
- Evidence of malnutrition/cachexia
- Generalised abdominal tenderness
- Abdominal bruits
What are the differentials for chronic, non-specfiic abdominal pain?
- Chronic pancreatitis
- Gallstone pathology
- Peptic ulcer disease
- Upper GI malignancy
What investigations are done in suspected chronic mesenteric ischaemia?
- Routine bloods, including FBC, U&Es, and LFTs
- CT angiography
What may be found on routine bloods in chronic mesenteric ischaemia?
They will usually be normal
Cardiovascular risk profile (lipids, glucose) may be abnormal
Why is CT angiography useful in the investigation of chronic mesenteric ischaemia?
- Provides good anatomical view of all vessels
- Can help gauge any intervention required
What used to be the gold standard of imaging in chronic mesenteric ischaemia?
Catheter angiography, but now used less due to the improvement of CT angiography
Who decides on the management plans for chronic mesenteric ischaemia?
Typically made jointly between interventional radiologists and vascular surgeons
