Bowel Ischaemia

Question 1

what are the three main types of bowel ischaemia?

Answer 1

1. Acute mesenteric ischaemia
2. Chronic mesenteric ischaemia
3. Ischaemic Colitis

Question 2

RF for bowel ischaemia

Answer 2

age 
AF (especially for mesenteric) 
CVS disease 
diabetes 
HTN 
smoking 
emboli

Question 3

Features of bowel ischaemia

Answer 3

abdo pain
rectal bleeding
diarrhoea
high WCC - due to lactic acidosis

Question 4

what is you Ix of choice for bowel ischaemia?

Answer 4

CT

Question 5

Acute Mesenteric Ischaemia

caused by an emboli resulting in occlusion in which artery?

this artery supplies which part of bowel?

classically patients have a Hx of ?

classic triad of symptoms?

pain is where?

complication?

Tx?

Answer 5

superior mesenteric artery

small bowel

AF

Severe abdo pain
Hypovolaemia from shock
No abdo signs

central and constant

septic peritonitis

urgent surgery - remove dead bowel +/- revascularization

Question 6

Chronic Mesenteric Ischaemia

is it common or rare?

triad of what symptoms?

Tx?

Answer 6

rare

triad of colicky intermittent abdo pain, low weight (eating hurts), upper abdo bruit

usually supportive, surgery may be required if peritonism/ perforation

Question 7

Ischaemic Colitis

affects which artery

supplying which part of bowel?

symptoms?

Ix?

Tx?

Answer 7

inferior mesenteric artery

large bowel

lower left sided abdo pain
bloody diarrhoea

thumbprinting on AXR due to mucosal oedema and haemorrhage

Tx = supportive, surgery may be indicated if peritonism or perforation