Bowel Ischaemia

Question 1

What are the risk factors for bowel ischaemia?

Answer 1

AF (esp mesenteric ischaemia); endocarditis or malignancy - cause emboli; HF, CKD, Previous MI, thrombophilia, CV risk factors, cocaine (ischaemic colitis in young)

Question 2

What are the clinical features of bowel ischaemia?

Answer 2

Abdo pain, rectal bleeding, diarrhoea, fever, elevated WBCs assoc with lactic acidosis

Question 3

How is bowel ischaemia diagnosed?

Answer 3

CT

Question 4

Where are the clinical features of mesenteric ischaemia?

Answer 4

typically small bowel, due to embolism, sudden onset, severe symptoms

Question 5

What is acute mesenteric ischaemia?

Answer 5

Embolism resulting in occlusion of an artery. Classically patients have a history of AF. Abdo pain is typically severe, of sudden onset and out-of-keeping with physical exam findings.

Question 6

What is treatment of acute mesenteric ischaemia?

Answer 6

Urgent surgery

Question 7

How does chronic mesenteric ischaemia?

Answer 7

Non-specific features. Colickly, intermittent abdominal pain occurs.

Question 8

What are the clinical features of ischaemic colitis?

Answer 8

Affects large bowel, transient and less sever symptoms, blood diarrhoea, thumb-printing on AXR

Question 9

What is ischaemic colitis

Answer 9

Acute but transient compromise in the blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage.

Question 10

What causes thumbprinting on AXR?

Answer 10

mucosal oedema/haemorrhage

Question 11

How is ischaemic colitis treated

Answer 11

Conservative management