Chronic Mesenteric Ischaemia

Question 1

What is Chronic Mesenteric Ischaemia

Answer 1

Athersclerotic plaque build up in the coeliac trunk, SMA and IMA
Causes reduced blood supply to bowel

Question 2

What are the symptoms

Answer 2

Postprandial pain - 10mins-4hrs after eating - may be associated with a fear of eating (linked with pain)
Weight loss - malabsorption and fear of eating due to pain
Concurrent vascular comorbidities e.g. previous MI, Stroke, PVD

Question 3

Why is there symptoms after eating

Answer 3

Increase in demand in blood supply (eating) or a reduction in supply (hypovolaemic state)
causing transient ischaemia and symptoms

Question 4

What will be found upon examination of the abdomen

Answer 4

Non specific symptoms

• malnutrition/cachexia
• Generlised abdominal tenderness
• abdominal bruits

Question 5

What are the differentials?

Answer 5

Chronic pancreatitis - faecal elastase will be raised (sensitive marker)
Gallstones - colicky pain after food in RUQ
Peptic ulcers - worse after eating, may have H. pylori infection, may take NSAIDs
Upper GI malignancy - weight loss, lethargy, night sweats, early satiety

Question 6

Who is more likely to be affected by Chronic Mesenteric Ischaemia

Answer 6

Patients over 60 years 
more common in females 
Smoker 
Hypertension 
Diabetes 
Hypercholesterolaemia

Question 7

Which investigations would be done in suspected Chronic Mesenteric Ischaemia

Answer 7

Bedside obs
Bloods - FBC, U+Es, LFTs
Anaemia may be a confounding factor and CVS profile may be abnormal
Imaging - CT angiography

Question 8

How is it managed?

Answer 8

best medical therapy 
- smoking cessation 
- diet 
- regular exercise
- statins 
- antiplatelets
- HTN management 
- diabetes management
Surgical intervention 
- endovascular procedure 
- Open procedure

Question 9

When is surgical intervention considered

Answer 9

Severe disease
Progressive disease
Debilitating symptoms - weight loss, malabsorption

Question 10

What are the surgical interventions

Answer 10

Endovascular - Mesenteric angioplasty with stenting
through the femoral, brachial or axillary
Risks: haematoma, vessel perforation, embolism

Open - endarectomy or bypass procedure

Question 11

What are the complications of Chronic Mesenteric Ischaemia

Answer 11

Bowel infarction with necrosis

Malaabsorption