Intestinal Ischaemia Flashcards
What is intestinal ischaemia.
Reduction in intestinal blood flow causes ischaemia.
What are the two most common symptoms of intestinal ischaemia. (2)
Pain after eating.
Weight loss.
Who is typically affected by intestinal ischaemia.
The elderly.
Where does intestinal ischaemia tend to occur..
At the watershed area.
Where is the watershed area.
Splenic flexure and distal colon junction.
What typically prompts you to think of mesenteric ischaemia. (2)
AF with abdominal pain.
What are the three main forms of intestinal ischaemia. (3)
Acute mesenteric ischaemia.
Chronic mesenteric ischaemia.
Chronic colonic ischaemia.
What are the causes of acute ischaemia in the bowel. (8)
Thrombotic. Embolic. Non-occlusive (20%). Venous (5%). Traume. Vesculitis. Radiotherapy. Strangulation (eg volvulus or hernia).
What is chronic intestinal ischaemia usually due to. (2)
Usually a combination of low flow states with atheroma.
What is the most common cause of acute intestinal ischaemia.
Arterial thrombosis.
What part of the bowel is usually affected in acute mesenteric ischaemia. (2)
Almost always involves the small bowel.
May follow the path of the SMA.
What are the causes of non-occlusive acute mesenteric ischaemia. (3)
Usually reflects low flow states:
Poor cardiac output.
Recent cardiac surgery.
Renal failure.
What is the typical presentation of acute mesenteric ischaemia. (3)
Classical clinical triad:
Acute severe abdominal pain.
No abdominal signs.
Rapid hypovolvaemia leading to shock.
What are the characteristics of the abdominal pain in acute mesenteric ischaemia. (3)
Constant, centra or around the RIF.
What may be observed on the blood tests of a patient with acute mesenteric ischaemia. (4)
Raised HB (due to plasma loss). Raised WCC. Modestly raised plasma amylase. Persistent metabolic acidosis.
What does this set of blood results lead you to believe:Raised HB (due to plasma loss).
Raised WCC.
Modestly raised plasma amylase.
Persistent metabolic acidosis.
Acute mesenteric ischaemia.
What is seen on an AXR of a patient with acute mesenteric ischaemia.
A gasless abdomen.
what are the two main complications of acute mesenteric ischaemia. (2)
Septic peritonitis.
Progression of a systemic inflammatory response syndrome (SIRS).
What is another name for chronic mesenteric ischaemia.
Intestinal angina.
What is the typical clinical triad seen in chronic mesenteric ischaemia. (6)
Severe, colicky post-prandial abdominal pain. ('gut claudication').
Weight loss (pain on eating).
Upper abdominal bruit may be present.
There may be PR bleeding, malabsorption and nausea and vomiting.What is an important history in a patient presenting with chronic mesenteric ischaemia.
There may be a history of vascular disease.
What are 95% of chronic mesenteric ischaemia cases due to.
Due to diffuse atherosclerotic disease in all 3 mesenteric arteries.
What is another name for chronic colonic ischaemia.
Ischaemic colitis.
What is the pathological range of ischaemic colitis. (2)
Ranges from mild ischaemia to gangrenous colitis.
What area does chronic colonic ischaemia tend to affect.
It usually follows the low flow in the IMA territory.
What are the presentations of chronic colonic ischaemia. (2)
Lower left sided abdominal pain.
There may be bloody diarrhoea.
