GI - Mesenteric Ischaemia

Question 1

Mesenteric Ischaemia - what is it?

Answer 1

Lack of blood flow through the mesenteric vessels that supply the intestines, which results in intestinal ischaemia

Question 2

Mesenteric Ischaemia - what are the three branches that supply the abdo organs?

Answer 2

Coeliac artery

Superior mesenteric artery

Inferior mesenteric artery

Question 3

Mesenteric Ischaemia - what does the foregut, midgut and hindgut consist of, and what artery supplies each section?

Answer 3

Foregut:

1. Includes oesophagus, stomach, duodenum, pancreas, spleen, liver, biliary system
2. Supplied by Coeliac artery

Midgut:

1. From distal duodenum to first half of transverse colon
2. Supplied by Superior mesenteric artery

Hindgut:

1. From second half of transverse colon to rectum
2. Supplied by Inferior mesenteric artery

Question 4

Mesenteric Ischaemia - what is chronic mesenteric ischaemia?

Answer 4

Also known as intestinal angina

Is a result of narrowing of the mesenteric vessels due to atherosclerosis. therefore causes intermittent abdo pain, much like in angina in the heart

Question 5

Mesenteric Ischaemia - what is the classic triad?

Answer 5

1. Intermittent (colicky) central abdo pain after eating (30 mins after eating)
2. Abdo bruit on auscultation
3. Weight loss - due to avoiding food because it causes pain

Question 6

Mesenteric Ischaemia - what are the risk factors for chronic mesenteric ischaemia?

Answer 6

Same as in any other CV disease

1. Diabetes
2. Smoking
3. HTN
4. Family History

Question 7

Mesenteric Ischaemia - how do you diagnose chronic mesenteric ischaemia?

Answer 7

CT angiography

Question 8

Mesenteric Ischaemia - what is the management of chronic mesenteric ischaemia?

Answer 8

1. Improve modifiable RFs

2. Revascularisation - to improve blood flow to intestines, percutaneous mesenteric artery stenting (1st line)

Question 9

Mesenteric Ischaemia (acute) - what is it?

Answer 9

Acute Mesenteric Ischaemia is TYPICALLY caused by the rapid blockage of blood flow through the SUPERIOR MESENTERIC ARTERY

Question 10

Mesenteric Ischaemia (acute) - what is it caused by?

Answer 10

Thrombus

Emboli - developed from another site

Question 11

Mesenteric Ischaemia (acute) - what is the main RF?

Answer 11

Atrial Fibrillation

Thrombus forms in RA, mobilises (thromboembolism) down aorta and into Superior Mesenteric Artery

Question 12

Mesenteric Ischaemia (acute) - what is the classical presentation?

Answer 12

Pain is disproportionate to examination findings

Acute, no-specific abdo pain

Patients can go onto develop shock, peritonitis and sepsis

Question 13

Mesenteric Ischaemia (acute) - what complications can it lead to?

Answer 13

Patients can go onto develop shock, peritonitis and sepsis

Ischaemia to bowel can result in bowel tissue necrosis and perforation

Question 14

Mesenteric Ischaemia (acute) - what is the diagnostic investigation of choice?

Answer 14

Contrast CT - can see bowel and blood supply

will also have raised lactate because lack of 02

Question 15

Mesenteric Ischaemia (acute) - what is the treatment?

Answer 15

Surgery:

1. Remove necrotic bowel
2. Remove or bypass thrombus in vessel

Question 16

Mesenteric Ischaemia (acute) - what is the mortality rate?

Answer 16

Over 50%