Intestinal Ischaemia

Question 1

What is intestinal ischaemia.

Answer 1

Reduction in intestinal blood flow causes ischaemia.

Question 2

What are the two most common symptoms of intestinal ischaemia. (2)

Answer 2

Pain after eating.

Weight loss.

Question 3

Who is typically affected by intestinal ischaemia.

Answer 3

The elderly.

Question 4

Where does intestinal ischaemia tend to occur..

Answer 4

At the watershed area.

Question 5

Where is the watershed area.

Answer 5

Splenic flexure and distal colon junction.

Question 6

What typically prompts you to think of mesenteric ischaemia. (2)

Answer 6

AF with abdominal pain.

Question 7

What are the three main forms of intestinal ischaemia. (3)

Answer 7

Acute mesenteric ischaemia.
Chronic mesenteric ischaemia.
Chronic colonic ischaemia.

Question 8

What are the causes of acute ischaemia in the bowel. (8)

Answer 8

Thrombotic. 
Embolic. 
Non-occlusive (20%). 
Venous (5%). 
Traume. 
Vesculitis. 
Radiotherapy. 
Strangulation (eg volvulus or hernia).

Question 9

What is chronic intestinal ischaemia usually due to. (2)

Answer 9

Usually a combination of low flow states with atheroma.

Question 10

What is the most common cause of acute intestinal ischaemia.

Answer 10

Arterial thrombosis.

Question 11

What part of the bowel is usually affected in acute mesenteric ischaemia. (2)

Answer 11

Almost always involves the small bowel.

May follow the path of the SMA.

Question 12

What are the causes of non-occlusive acute mesenteric ischaemia. (3)

Answer 12

Usually reflects low flow states:
Poor cardiac output.
Recent cardiac surgery.
Renal failure.

Question 13

What is the typical presentation of acute mesenteric ischaemia. (3)

Answer 13

Classical clinical triad:
Acute severe abdominal pain.
No abdominal signs.
Rapid hypovolvaemia leading to shock.

Question 14

What are the characteristics of the abdominal pain in acute mesenteric ischaemia. (3)

Answer 14

Constant, centra or around the RIF.

Question 15

What may be observed on the blood tests of a patient with acute mesenteric ischaemia. (4)

Answer 15

Raised HB (due to plasma loss). 
Raised WCC. 
Modestly raised plasma amylase. 
Persistent metabolic acidosis.

Question 16

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.

Answer 16

Acute mesenteric ischaemia.

Question 17

What is seen on an AXR of a patient with acute mesenteric ischaemia.

Answer 17

A gasless abdomen.

Question 18

what are the two main complications of acute mesenteric ischaemia. (2)

Answer 18

Septic peritonitis.

Progression of a systemic inflammatory response syndrome (SIRS).

Question 19

What is another name for chronic mesenteric ischaemia.

Answer 19

Intestinal angina.

Question 20

What is the typical clinical triad seen in chronic mesenteric ischaemia. (6)

Answer 20

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.

Question 21

What is an important history in a patient presenting with chronic mesenteric ischaemia.

Answer 21

There may be a history of vascular disease.

Question 22

What are 95% of chronic mesenteric ischaemia cases due to.

Answer 22

Due to diffuse atherosclerotic disease in all 3 mesenteric arteries.

Question 23

What is another name for chronic colonic ischaemia.

Answer 23

Ischaemic colitis.

Question 24

What is the pathological range of ischaemic colitis. (2)

Answer 24

Ranges from mild ischaemia to gangrenous colitis.

Question 25

What area does chronic colonic ischaemia tend to affect.

Answer 25

It usually follows the low flow in the IMA territory.

Question 26

What are the presentations of chronic colonic ischaemia. (2)

Answer 26

Lower left sided abdominal pain.

There may be bloody diarrhoea.