Chronic mesenteric ischaemia Flashcards
What is Chronic mesenteric ischaemia?
Reduced blood supply to the bowel which gradually deteriorates over time as a result of atherosclerosis in the coeliac trunk, SMA and IMA
What causes chronic mesenteric ischaemia?
atherosclerotic plaques which narrows the lumen, impairs blood flow to the supplied viscera, so inadequate blood supply
To get symptoms in chronic mesenteric ischaemia, what needs to happen to the blood supply?
Coeliac, SMA and IMA, usually need 2 of these to be occluded for symptoms, also in increased demand e.g. eating, reduced blood volume etc
What are the risk factors for chronic mesenteric ischaemia?
smoking, hypertension, diabetes mellitus and hypercholesterolemia
What are the clinical features of chronic mesenteric ischaemia?
postprandial pain- classically occurring around 10mins-4hours after eating, weight loss- a combination of decreased calorie intake and malabsorption, concurrent vascular comorbidities- previous MI, stroke or PVD, change in bowel habit, nausea, vomit,
What are the differential diagnosis for chronic mesenteric ischaemia?
chronic pancreatitis, gallstone pathology, peptic ulcer disease, upper GI malignancy
What are the investigations for chronic mesenteric ischaemia?
blood tests will usually be normal, anaemia may be confounding symptom, cardiovascular risk profile, CT angiography
What is the management for chronic mesenteric ischaemia?
modify risk factors e.g. smoking cessation, anti-platelet and statin therapy, endovascular or open procedure, endovascular is preferred
What is mesenteric angioplasty?
Performed percutaneously through the femoral or brachial/axillary artery allowing a catheter to be passed, balloon is expanded to dilate the vessel and stenting occurs
What are the complications of chronic mesenteric ischaemia?
bowel infarction or malabsorption
