Mesenteric ischaemia

Question 1

What artery supplies the:
i. foregut
ii. midgut
iii. hindgut

Answer 1

i. coeliac artery
ii. superior mesenteric artery
iii. inferior mesenteric artery

Question 1

What is it ?

Answer 1

Lack of blood flow through the mesenteric vessels supplying the intestines resulting in ischaemia

Question 2

What is chronic mesenteric ischaemia

Answer 2

Narrowing of the mesenteric blood vessels by atherosclerosis

Question 3

What is the presentation of chronic mesenteric ischaemia?

Answer 3

1. Central colicky abdo pain after eating
2. Weight loss - avoids food due to pain
3. Abdo bruit

Question 4

how is chronic mesenteric ischaemia diagnosed?

Answer 4

CT angiography

Question 5

What is the management of chronic MI?

Answer 5

Reduce modifiable risk factors
secondary prevention
Revascularisation

Question 6

How is revascularisation performed?

Answer 6

Endovascular procedures - percutaneous mesenteric artery stenting
Open surgery e.g. endarterectomy, bypass

Question 7

What is a key risk factor of acute MI?

Answer 7

AF - thrombus forms in left atrium then mobilises down aorta to superior mesenteric artery

Question 8

How does acute mI present?

Answer 8

Acute
Non-specific abdominal pain
Pain disproportionate to exam findings

Question 9

What is the test for acute mesenteric ischaemia?

Answer 9

Contrast CT

Question 10

What results may you see on VBG in acute mi?

Answer 10

metabolic acid
raised lactate

Question 11

What is treatment for acute mesenteric ischaemia ?

Answer 11

Remove necrotic bowel
Remove or bypass thrombus