chronic mesenteric ischaemia

Question 1

what is chronic mesenteric ischaemia?

Answer 1

caused by a reduced blood supply which gradually deteriorates over time as a result of atherosclerosis in the coeliac trunk, superior mesenteric artery and/or the inferior mesenteric artery

Question 2

what demographic usually suffer from CMI?

Answer 2

females

> 60yrs

Question 3

why are patients with atherosclerotic disease in the mesenteric vessels often asymptomatic, and what is needed to become symptomatic?

Answer 3

Due to collateral circulation

As a result, at least 2 of the coeliacs, SMA and IMA must be affected for patient to be symptomatic

at rest usually asymptomatic, but increased demand e.g after eating, or reduced blood volume e.g haemorrhage will exacerbate symptoms

Question 4

what is the pathophysiology of chronic mesenteric ischaemia?

Answer 4

The gradual build-up of atherosclerotic plaque within the mesenteric vessels narrows the lumen, impairing blood flow to the supplied viscera, resulting in an inadequate blood supply to the bowel.

Question 5

what are the risk factors for chronic mesenteric ischaemia?

Answer 5

• smoking
• hypertension
• DM
• hypercholesterolemia

Question 6

what are the clinical features of chronic mesenteric ischaemia?

Answer 6

• postprandial pain (10mins-4hrs after eating)
• weight loss (decreased calorie intake and malabsorption)
• concurrent vascular co morbidities e.g previous MI
• loose stools
• nausea and vomitting
• generalised abdominal tenderness
• abdominal bruits
• evidence of malnutrition/cachexia

Question 7

what are the differentials for Chronic non specific abdominal pain?

Answer 7

• chronic pancreatitis
• gallstone pathology
• peptic ulcer disease
• upper GI malignancy

Question 8

what investigations can be done for chronic mesenteric ischaemia?

Answer 8

• bloods. check Mg and Ca due to malnutrition
• anaemia may be confounding symptoms and CV risk profile factors e.g lipids or blood glucose may be anormal
• CT angiography is test of choice

Question 9

how is chronic mesenteric ischaemia managed conservatively?

Answer 9

• lifestyle changes

- commence platelet and statin therapy to minimise progression

Question 10

how is chronic mesenteric ischaemia managed surgically?

Answer 10

in severe and progressive disease with debilitating seasons

1) Endovascular procedures (more common) – consists of mesenteric angioplasty with stenting
2) Open procedures (less common) – either an endartectomy or a bypass procedure

Question 11

what are the complications of chronic mesenteric ischaemia?

Answer 11

main complications are

• bowel infarction
• malabsorption

patients usually have concurrent CV disease which will also need management