Mesenteric ischaemia

Question 1

1) What causes chronic mesenteric ischaemia?
2) The typical presentation of chronic mesenteric ischaemia is a triad of what 3 things?
3) The risk factors for mesenteric ischaemia is the same as what?
4) What is the first investigation?
5) How is it diagnosed?

Answer 1

1) Narrowing of the mesenteric blood vessels by atherosclerosis
2) Central colicky abdominal pain after eating, weight loss and abdominal bruit on auscultation
3) Cardiovascular disease
4) Serum lactate
5) CT angiography

Question 2

Name 2 aspects of the management of mesenteric ischaemia

Answer 2

• Reducing modifiable risk factors
• Secondary prevention i.e. statins
• Revascularisation

Question 3

Name a method of achieving revascularization

Answer 3

• Endovascular procedures first-line i.e. percutaneous mesenteric artery stenting
• Open surgery i.e endarterectomy, re-implantation or bypass grafting

Question 4

1) What typically causes acute mesenteric ischaemia?
2) How does acute mesenteric ischaemia usually present?
3) Over time, name 1 thing acute bowel ischaemia will result in

Answer 4

1) Rapid blockage in blood flow through the superior mesenteric artery due to a thrombus or an embolus
2) Acute, non-specific abdominal pain
3) Necrosis of the bowel tissue and perforation

Question 5

1) What is the diagnostic test of choice?
2) How is acute mesenteric ischaemia managed?
3) Name a complication of acute mesenteric ischaemia

Answer 5

1) Contrast CT
2) Surgery either to remove the bowel or remove or bypass the thrombus in the blood vessel
3) Shock, peritonitis and sepsis