Chronic mesenteric ischaemia

Question 1

Chronic mesenteric ischaemia

Answer 1

Reduced blood supply to the bowel which gradually deteriorates over time due to atherosclerosis in the coeliac trunk, superior mesenteric artery and/or inferior mesenteric artery

Question 2

Risk factors

Answer 2

> 60yrs
Female

HTN
Hypercholesterolaemia
Smoking
DM

Question 3

Symptomatic

Answer 3

Collateral blood supply means that commonly at least two of the Coeliac, SMA, and IMA must be affected

Question 4

Clinical features

Answer 4

Postprandial pain – around 10mins-4hrs after eating

Weight loss – decreased calorie intake and malabsorption

Concurrent vascular co-morbidities, e.g. previous MI, stroke, or PVD

Less specific:

• change in bowel habit
• N+V
• abdo tenderness and bruits

Question 5

Investigations

Answer 5

Abdo exam
Obs

Bloods - including FBC, U&Es, and LFTs, lipids, electrolytes due to malnutrition

CT angiogram

Question 6

Management

Answer 6

Risk reduction

• smoking cessation
• anti - platelet
• statin therapy

Surgery:

• endovascular mesenteric angioplasty with stenting
• or open endartectomy or a bypass

Question 7

Mesenteric angioplasty

Answer 7

Performed percutaneously, through either the femoral artery or brachial/axillary artery, allowing a catheter to be passed to the appropriate vessel under radiological guidance

Question 8

Complications of chronic mesenteric ischaemia

Answer 8

Bowel infarction or malabsorption