Intestinal Ischaemia

Question 1

What is intestinal ischaemia?

Answer 1

obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis

Question 2

What is the epid of intestinal ischaemia?

Answer 2

• Uncommon

* More common in elderly

Question 3

What are RF for intestinal sichaemia?

Answer 3

1. Increasing age
2. Atrial fibrillation - particularly for mesenteric ischaemia
3. Other causes of emboli: endocarditis, malignancy
4. Cardiovascular disease risk factors: smoking, hypertension, diabetes

Question 4

What are the different types of intestinal ischaemia?

Answer 4

1. acute mesenteric ischaemia
2. chronic mesenteric ischaemia
3. ischaemic colitis

Question 5

What are the different types of acute mesenteric ischaemia?

Answer 5

1. arterial
2. venous
3. non-occlusive

Question 6

What does arterial acute mesenteric ischaemia involve?

Answer 6

almost always involves small bowel

Question 7

What vessel does arterial acute mesenteric ischaemia affect?

Answer 7

superior mesenteric artery (75%)

Question 8

What are the causes for arterial acute mesenteric ischaemia?

Answer 8

arterial thrombosis (35%) or embolism (35%) – atrial fibrillation, endocarditis

Question 9

What is venous acute mesenteric ischaemia due to?

Answer 9

venous thrombosis

Question 10

What is non-occlusive acute mesenteric ischaemia due to?

Answer 10

hypoperfusion – shock, heart failure, volvulus

Question 11

What is chronic mesenteric ishcaemia due to?

Answer 11

due to a low flow state Likely to have Hx of vascular disease

Question 12

How common is chronic mesenteric ischaemia?

Answer 12

rare

Question 13

What is ischaemic colitis?

Answer 13

inflammation of the colon caused by decreased colonic blood supply

Question 14

What vessel is usually affected in intestinal ischaemia?

Answer 14

follows low flow state in inferior mesenteric artery

Question 15

What is ischaemic colitis due to?

Answer 15

1. thrombus/embolus
2. hypovolaemia
   3 hypercoagulable state

Question 16

What are symptoms and signs of intestinal ischaemia?

Answer 16

1. Abdo pain: colicky, intermittment
2. Rectal bleeding
3. Diarrhoea
4. Fever

Question 17

What is the abdo pain for different types of intestinal ischaemia?

Answer 17

abdo pain severe + sudden onset for acute mesenteric ischaemia – other two are more chronic in development

Question 18

Where is the abdo pain in ischaemic colitis?

Answer 18

usually lower L sided in ischemic colitis (splenic flexure)

Question 19

What investigations are used for intestinal ischaemia?

Answer 19

1. 1st line: VBG: raised lactate (acidosis)
2. CT
3. Barium enema

Question 20

What does barium enema show in ischamic colitis?

Answer 20

Thumbprint on barium enema for ischaemic colitis

Question 21

What is the management for acute mesenteric ishcamia?

Answer 21

1. Fluid resuscitation
2. ABx to prevent bacterial translocation
3. Heparin/thrombolytic
4. Needs urgent surgery

Question 22

What is the management for chronic mesenteric ischaemia?

Answer 22

1. Surgery to prevent ongoing risk of infarction

2. Stent insertion to revascularize

Question 23

What is the management for ischaemic colitis?

Answer 23

1. Conservative Mx: Fluids resuscitation, ABx

2. Surgery if conservative fails, or if perforation and/or peritonitis

Question 24

What are possible complications of intestinal ischaemia?

Answer 24

1. Perforation
2. Peritonitis
3. Multi-organ dysfunction syndrome
4. Gangrene
5. Intestinal obstruction

Question 25

What is the prognosis for intestinal ischaemia like?

Answer 25

depends on severity, extent and timing of ischaemic insult and comorbidities