Intestinal ischaemia

Question 1

What typically causes acute mesenteric ischaemia?

Answer 1

Acute mesenteric ischaemia is typically caused by an embolism resulting in occlusion of an artery supplying the small bowel, such as the superior mesenteric artery.

Classically patients have a history of atrial fibrillation.

Question 2

What are the characteristics of abdominal pain in acute mesenteric ischaemia?

Answer 2

The abdominal pain is typically severe, of sudden onset, and out-of-keeping with physical exam findings.

Question 3

What is the management for acute mesenteric ischaemia?

Answer 3

Immediate laparotomy is usually required, particularly if there are signs of advanced ischemia, such as peritonitis or sepsis.

Poor prognosis, especially if surgery is delayed.

Question 4

What is chronic mesenteric ischaemia?

Answer 4

Chronic mesenteric ischaemia is a relatively rare clinical diagnosis due to its non-specific features.

It may be thought of as ‘intestinal angina’.

Question 5

What are the symptoms of chronic mesenteric ischaemia?

Answer 5

Colicky, intermittent abdominal pain occurs.

Question 6

What are the three main conditions associated with ischaemia to the lower gastrointestinal tract?

Answer 6

1. Acute mesenteric ischaemia
2. Chronic mesenteric ischaemia
3. Ischaemic colitis

Question 7

What are common predisposing factors for bowel ischaemia?

Answer 7

1. Increasing age
2. Atrial fibrillation
3. Other causes of emboli (endocarditis, malignancy)
4. Cardiovascular disease risk factors (smoking, hypertension, diabetes)
5. Cocaine use

Question 8

What are common features of bowel ischaemia?

Answer 8

1. Abdominal pain
2. Rectal bleeding
3. Diarrhoea
4. Fever
5. Elevated white blood cell count and lactic acidosis

Question 9

What is the investigation of choice for diagnosing bowel ischaemia?

Answer 9

CT scan

Question 10

What typically causes acute mesenteric ischaemia?

Answer 10

An embolism resulting in occlusion of an artery supplying the small bowel, commonly the superior mesenteric artery.

Question 11

What is a classic symptom of acute mesenteric ischaemia?

Answer 11

Severe abdominal pain of sudden onset, often out-of-keeping with physical exam findings.

Question 12

What is the management approach for acute mesenteric ischaemia?

Answer 12

Urgent surgery is usually required; prognosis is poor if surgery is delayed.

Question 13

How is chronic mesenteric ischaemia characterized?

Answer 13

It is characterized by colicky, intermittent abdominal pain and is often referred to as ‘intestinal angina’.

Question 14

What does ischaemic colitis describe?

Answer 14

An acute but transient compromise in blood flow to the large bowel, leading to inflammation, ulceration, and haemorrhage.

Question 15

Where is ischaemic colitis more likely to occur?

Answer 15

In ‘watershed’ areas such as the splenic flexure, located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

Question 16

What may be seen on abdominal x-ray in cases of ischaemic colitis?

Answer 16

‘Thumbprinting’ due to mucosal oedema/haemorrhage.

Question 17

What is the management for ischaemic colitis?

Answer 17

Usually supportive; surgery may be required if conservative measures fail, indicated by generalised peritonitis, perforation, or ongoing haemorrhage.

Question 18

What is ischaemic colitis?

Answer 18

Ischaemic colitis describes an acute but transient compromise in the blood flow to the large bowel.

Question 19

What are the potential consequences of ischaemic colitis?

Answer 19

It may lead to inflammation, ulceration and haemorrhage.

Question 20

Where is ischaemic colitis more likely to occur?

Answer 20

It is more likely to occur in ‘watershed’ areas such as the splenic flexure.

Question 21

What are ‘watershed’ areas?

Answer 21

‘Watershed’ areas are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

Question 22

What imaging finding may be seen in ischaemic colitis?

Answer 22

‘Thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage.