Mesenteric Ischaemia

Question 1

What are the 3 main vessels supplying the abdominal organs and which do each of the these vessels supply?

Answer 1

Coeliac artery:
-foregut= oesophagus- sphincter of Oddi of duodenum + biliary system, liver, pancreas, spleen

Superior mesenteric artery
-midgut= distal duodenum to 1st 1/2 transverse colon

Inferior mesenteric artery
-hindgut= 2nd 1/2 transverse colon to rectum

Question 2

What is chronic mesenteric ischaemia/intestinal angina? What causes it and what is the classic triad of presentations?

Answer 2

Narrowing of mesenteric BV due to atherosclerosis leading to blood supply being unable to meet demand

Cause= atherosclerosis and the risk factors associated

Triad:
-central colicky abdominal pain after eating
-weight loss (associated with food avoidance)
Abdominal bruit

Question 3

How does acute mesenteric ischaemia differ from chronic?

Answer 3

Blockage of blood flow due to thrombus in BV (superior mesenteric typically)

Question 4

What are the key risk factors for acute mesenteric ischaemia?

Answer 4

AF= thrombus forms is atria and then mobilises to become stuck in superior mesenteric artery

Question 5

What is a key presentation of acute mesenteric ischaemia?

Answer 5

Abdominal pain is disproportionate to the examination findings and clinical picture

Question 6

What investigations need to be done to diagnose acute mesenteric ischaemia?

Answer 6

Contrast CT= can see bowel and blood supply
FBC= raised WCC
U+E= electrolyte disturbance
VBG= signs of metabolic acidosis and raised lactate
Group and save= incase surgery required