Bowel ischaemia

Question 1

What are the 3 types of ischaemia to the lower GI tract?

Answer 1

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

Question 2

What are 5 predisposing factors to bowel ischaemia?

Answer 2

1. Increasing age
2. Atrial fibrillation - particularly for mesenteric ischaemia
3. Other causes of emboli: endocarditis, malignancy
4. Cardiovascular disease risk factors: smoking, hypertension, diabetes
5. Cocaine: ischaemic colitis sometimes seen in young patients following cocaine use

Question 3

What are 5 common clinical features of ischaemia to the lower GI tract?

Answer 3

1. Abdominal pain: in acute mesenteric ischaemia, this is often of sudden onset, severe and out of keeping with physical exam findings
2. Rectal bleeding
3. Diarrhoea
4. Fever
5. Bloods typically show elevated WCC associated with a lactic acidosis

Question 4

What is the investigation of choice in bowel ischaemia?

Answer 4

CT

Question 5

What typically causes acute mesenteric ischaemia?

Answer 5

typically caused by an embolism resulting in occlusion of an artery which supplies the small bowel, e.g. the superior mesenteric artery

typically history of atrial fibrillation

Question 6

What is typically present in the past medical history of someone presenting with acute mesenteric ischaemia?

Answer 6

atrial fibrillation

Question 7

What is the nature of the abdominal pain in acute mesenteric ischaemia?

Answer 7

typically severe, of sudden onset and out-of-keeping with physical exam findings

Question 9

What is the prognosis of acute mesenteric ischaemia?

Answer 9

poor prognosis, especially if surgery delayed

Question 10

How common is a diagnosis of chronic mesenteric ischaemia and why?

Answer 10

relatively rare, due to non-specific features - may be thought of as intestinal angina

Question 11

What is the nature of pain in chronic mesenteric ischaemia?

Answer 11

colicky, intermittent abdominal pain

Question 12

What is meant by ischaemic colitis?

Answer 12

acute but transient compromise in the blood flow to the large bowel

Question 13

What can ischaemic colitis lead to?

Answer 13

inflammation, ulceration and haemorrhage

Question 14

Which areas are more likely to be affected by ischaemic colitis?

Answer 14

‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries

Question 15

What is a key investigation to perform in suspected ischaemic colitis and what will it show?

Answer 15

AXR: thumbprinting due to mucosal oedema/ haemorrhage

Question 16

What is the management of ischaemic colitis?

Answer 16

supportive

surgery in small number of cases if this fails, e.g. generalised peritonitis, perforation, ongoing haemorrhage

Question 17

Which type of bowel is typically affected by ischaemic colitis?

Answer 17

large bowel

Question 18

Which type of bowel is usually affected by mesenteric ischaemia?

Answer 18

small bowel