Intestinal ischaemia

Question 1

define intestinal ischaemia?

Answer 1

obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis

• acute mesenteric ischaemia
• chronic mesenteric ischeamia
• ischaemic colitis

Question 2

what is acute mesenteric ischaemia?

Answer 2

Embolism which occludes an artery supplying small bowel. E.g. Superior mesenteric artery.

Question 3

what is chronic mesenteric ischaemia?

Answer 3

intestinal angina

Question 4

what is ischaemic colitis?

Answer 4

Acute but transient compromise in the blood flow to the large bowel. Occurs in the watershed areas.

Question 5

what are the major risk factors of bowel ischaemia?

Answer 5

o Old age
o AF – mesenteric ischaemia
o causes of emboli- endocarditis, malignancy
o CVS risk- smoking, hypertension, diabetes
o Cocaine - ischaemic colitis

Question 6

what can bowel ischamia be a consequence of?

Answer 6

o Volvulus
o Intussusception
o Bowel strangulation
o Failed surgical resection

Question 7

presenting symptoms of acute mesenteric ischaemia?

Answer 7

o Severe, sudden onset pain

Question 8

presenting symptoms of chronic mesenteric ischaemia?

Answer 8

o colicky intermittent abdominal pain

Question 9

presenting symptoms of ischaemic colitis?

Answer 9

o Inflammation
o Ulceration
o Haemorrhage
o Occurs in the watershed region

Question 10

signs of intestinal ischaemia on physical examination ?

Answer 10

• Diffuse abdominal tenderness
• Abdominal distension
• Tender palpable mass
• Bowel sounds may be absent
• Disproportionate degree of cardiovascular collapse

Question 11

investigations of intestinal ischaemia?

Answer 11

•	AXR – THUMBPRINTING 
•	Bloods 
o	ABG - lactic acidosis  
o	FBC 
o	U&Es 
o	LFTs  
o	Clotting  
o	Cross-match  
•	Mesenteric Angiography