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Gastrointestinal > Ischaemia & the bowel > Flashcards

Ischaemia & the bowel Flashcards

1
Q

What is ischaemia?

A

Inadequate blood supply to an organ or part of the body

The cells do not receive enough oxygen or glucose to keep them alive

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2
Q

What causes bowel ischaemia?

A

Thrombus or embolus

Aortic dissection

Trauma
Vasculitis
Radiotherapy
Strangulation eg. volvulus or hernia

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3
Q

Name the 2 types of bowel ischaemia?

Briefly what are the differences?

A

Mesenteric ischaemia: affects small bowel

Ischaemic colitis: affects large bowel

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4
Q

Which arteries commonly become occluded?

A

Splanchnic arteries:

  • Superior mesenteric
  • Coeliac arteries
  • Renal arteries

Bifurcation of the aorta

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5
Q

What does the superior mesenteric artery supply?

A

From lower duodenum to 2/3 across transverse colon

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6
Q

What does the inferior mesenteric artery supply?

A

Distal 1/3 of transverse colon down to rectum

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7
Q

There are two types of mesenteric ischaemia. What are they?

A

Acute + chronic

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8
Q

What causes acute mesenteric ischaemia?

A

A thrombus or embolus usually

Other causes: trauma, infection, tumour

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9
Q

Clinical features of acute mesenteric ischaemia?

A

Acute, severe abdominal pain

Pain is diffuse

Rectal bleeding

Vomiting + diarrhoea

Shock

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10
Q

Why does acute mesenteric ischaemia lead to shock?

A

Because of the loss of blood you get hypovolaemia

Also, in severe cases bowel perforation can occur which leads to shock

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11
Q

What happens to the bowel when it is ischaemic?

A

It become starved of blood and therefore oxygen + glucose

Cells can’t respire, necrosis

Inflammation which escalates damage

Widespread necrosis leading to perforation of bowel wall

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12
Q

Investigations of acute mesenteric ischaemia?

A

From history: often patients appear far more unwell than the results of examination would
suggest

Bloods:

  • raised lactic acid
  • raised white cells
  • metabolic acidosis

AXR:
- Gasless abdomen

Angiography using CT/MRI: use contrast dye to see blockages

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13
Q

What complications can occur from acute mesenteric ischaemia?

A

Perforation of bowel causing peritonitis leading to sepsis

Systemic inflammatory response syndrome (SIRS)
Which can lead to Multi-organ dysfunction syndrome (MODS)

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14
Q

What is SIRS?

A

Systemic inflammatory response syndrome

Body’s immune system goes into overdrive as a response to sepsis or similar
Causing damage to the body

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15
Q

What is MODS?

A

Multi-organ dysfunction syndrome

Dysfunction of two or more organs so that homeostasis can’t be maintained without intervention

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16
Q

Treatment of acute mesenteric ischaemia?

A

Resuscitate: fluids

Analgesia

Treat sepsis: antibiotics, heparin to prevent DIC

Surgical revascularisation: stent, embolectomy

Surgery to remove damaged/necrotic bowel

17
Q

What is DIC?

A

Disseminated intravascular coagulation

18
Q

What causes chronic mesenteric ischaemia?

A

Low blood flow due to atherosclerosis

Similar to angina

19
Q

What are the clinical features of chronic mesenteric ischaemia?

A

Abdominal pain after eating

Unintentional weight loss

Vomiting

Anorexia: due to pain caused by eating

Rectal bleeding

20
Q

Why does chronic mesenteric ischaemia cause weight loss?

A

Less blood supply to bowel
Less ability to absorb nutrients from food

Malabsorption leading to weight loss

21
Q

Why do you need to be concerned by chronic mesenteric ischaemia?

A

Because acute mesenteric ischaemia is highly likely to occur

You want to prevent this

22
Q

Investigation of chronic mesenteric ischaemia?

A

CT or MRI angiography: contrast dye shows up blockages in blood vessels

USS could help show abnormal blood flow

23
Q

Treatment of chronic mesenteric ischaemia?

A

Surgical revascularisation: insert stent

Treat symptoms: analgesia

24
Q

What is ischaemic colitis?

A

Ischaemia affecting the colon!

Inflammation occurs because of the damage caused by ischaemia

25
Q

Which artery is mostly affected in ischaemic colitis?

A

Inferior mesenteric artery

26
Q

Clinical features of ischaemic colitis?

A

Lower left sided abdominal pain

Bloody diarrhoea
Pyrexia

Shock

27
Q

How severe is ischaemic colitis?

A

It’s very variable

Some are mildly affected and some develop sepsis and become fatally ill

28
Q

Investigations of ischaemic colitis?

A

CT scan maybe

Colonoscopy: look for evidence of ischaemic damage

Biopsy: lots of white cells, damaged necrotic cells

29
Q

Treatment of ischaemic colitis?

A

In mild to moderate cases supportive care is sufficient

  • fluids
  • antibiotics

In cases where peritonitis and sepsis have developed, resuscitation and resection of damaged bowel

30
Q

What often occurs in patients who recover from ischaemic colitis?

A

Strictures develop in the bowel

Gastrointestinal (20 decks)

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