Bowel Ischaemia

Question 1

Examples of bowel ischaemia disorders

Answer 1

Ischaemic colitis

Mesenteric ischaemia

Question 2

What is ischaemic colitis

Answer 2

Lack of blood supply to the colon causing inflammation and injury

Question 3

Clinical presentation of Ischaemic colitis

Answer 3

Abdominal pain and rectal bleeding

Occasionally shock

Question 4

Pathophysiology of Ischaemic colitis

Answer 4

Lack of blood flow to areas of the colon (usually the splenic flexure and caecum) causes pain and bleeding.

Question 5

Aetiology of Ischaemic colitis

Answer 5

Usually underlying atherosclerosis and vessel occlusion

Question 6

Epidemiology of Ischaemic colitis

Answer 6

More common in elderly

Question 7

Diagnosis of Ischaemic colitis

Answer 7

Sigmoidoscopy shows normal with some blood

Question 8

Treatment of Ischaemic colitis

Answer 8

Treat symptoms
Possible anticoagulants
Surgery may be required for gangrene, perforation or stricture formation

Question 9

Complications of Ischaemic colitis

Answer 9

Gangrene, perforation or stricture formation

Question 10

What is Mesenteric ischaemia

Answer 10

Lack of blood supply to the small intestine

Question 11

Types of mesenteric ischaemia

Answer 11

Acute

Chronic

Question 12

Clinical presentation of Acute mesenteric i

Answer 12

Triad: Severe abdo pain (constant, central or around the right iliac fossa)
No abdo signs
Rapid hypovolaemia resulting in shock (pale skin, weak rapid pulse, reduced urine output, confusion)

Moderate-severe- colicky/constant poorly localised pain, out of proportional to physical findings

Question 13

Pathophysiology of acute mesenteric ischaemia

Answer 13

Umbrella term, including embolus/thrombus, non-occlusive mesenteric ischaemia
Lack of blood flow to areas of the colon (usually the splenic flexure and caecum) causes pain

Question 14

Pathophysiology of chronic mesenteric ischaemia

Answer 14

Lack of blood flow to areas of colon (usually splenic flexure and caecum) causes pain
Can be all 3 major mesenteric arteries

Question 15

Clinical presentation of chronic mesenteric ischaemia

Answer 15

Moderate-severe- colicky/constant poorly localised pain, out of proportional to physical findings
Fear of eating, nausea, vomiting or bowel irregularity.

Question 16

Aetiology of acute mesenteric ischaemia

Answer 16

Superior Mesenteric Artery thrombosis
Superior mesenteric artery embolism
Mesenteric vein thrombosis
Non-occlusive disease
Arterial thrombosis/embolus
Aortic dissection

Question 17

Epidemiology of acute mesenteric ischaemia

Answer 17

> 50 years

Question 18

Diagnosis of acute mesenteric ischaemia

Answer 18

Laparotomy to make diagnosis
Abdominal X-ray (gas-LESS abdomen) to rule out other pathology
Bloods - raised HB due to plasma loss, raised WCC, metabolic acidosis
Angiography - shows arterial blockage

Question 19

Treatment of acute mesenteric ischaemia

Answer 19

Initial fluid resuscitation with IV
Antibiotics
Heparin (reduce clotting)
Surgical - angioplasty, embolectomy (remove dead bowel)

Question 20

Complications of acute mesenteric ischaemia

Answer 20

Septic peritonitis
Systemic inflammatory response syndrome
Poor outcome
Treatment mortality 50-80%

Question 21

Aetiology of chronic mesenteric ischaemia

Answer 21

Usually atherosclerosis

Question 22

Epidemiology of chronic mesenteric ischaemia

Answer 22

Average presentation of 60

Question 23

Diagnosis of chronic mesenteric ischaemia

Answer 23

Ultrasound, Arteriography

Question 24

Treatment of chronic mesenteric ischaemia

Answer 24

Surgical intervention.

Medical: in surgical contraindicated. Nitrates and anticoagulant

Question 25

Complications of chronic mesenteric ischaemia

Answer 25

Colitis

Question 26

Most common cause of acute mesenteric ischaemia

Answer 26

Superior Mesenteric artery thrombosis