Mesenteric Ischaemia (1*)

Question 1

What are the 3 main branches of the AA? What do they supply?

Answer 1

• Coeliac (Foregut) - supplies the stomach, proximal duodenum, biliary system, liver, pancreas, spleen
• Superior Mesenteric (Midgut) - supplies the distal duodenum to 1/2 transverse colon
• Inferior Mesenteric (Hindgut) - supplies the 2/2 transverse colon to rectum

Question 2

Chronic Mesenteric Ischaemia:
What occurs here?
→ What is it also known as?

What are its 2 main symptoms?

What may be heard O/E?

What are its risk factors?

What is used to diagnose it?

How is it managed?

Answer 2

➊ Atherosclerotic narrowing of mesenteric vessels, which results in intermittent abdominal pain when blood supply can’t keep up with the demand
→ Intestinal Angina

➋ • Diffuse, colicky abdominal pain after eating (starts 30 mins after, lasting 1-2 hrs)
• Weight loss (due to food avoidance as it causes pain)

➌ Abdominal bruit

➍ That of CVD e.g. age, smoking, diabetes, htn

➎ CT Angiogram

➏ • Reduce modifiable risk factors
• Secondary prevention e.g. statins and antiplatelet
• Revascularisation
‣ Endovascular i.e. percutaneous mesenteric artery stenting is 1st line here
‣ Open surgery

Question 3

Acute Mesenteric Ischaemia:
What occurs here?
→ Which artery is most commonly affected?

What is a key risk factor here?

How does it present?

What can it lead to?

Which investigations should be done?

What is used to diagnose it?

How is it managed?
→ For those that survive after surgery, what may they still suffer with?

Answer 3

➊ Rapid blockage of blood flow through intestinal artery
→ SMA

➋ AF

➌ • Acute, non-specific abdominal pain which is disproportionate to examination findings
• Guarding
• N+V

➍ Necrosis and perforation, which can then go on to cause peritonitis, sepsis, and shock

➎ • ABG and Lactate - Will show Metabolic acidosis and Raised lactate due to the ischaemia
• ECG – assess for AF

➏ CT Angiogram

➐ • Surgery to remove necrotic bowel
• Remove/bypass the clot
→ Short Gut syndrome