Mesenteric Ischaemia

Question 2

What is the aetioloy of acute mesenteric ischaemia?

Answer 2

Sudden decrease in blood supply to the bowel resulting in bowel ischaemia and death if left

• Thrombus in situ
• Embolism
• Non-occlusvie cause
• Venous occlusion and congestion

Question 3

What are some risk factors for acute mesenteric ischaemia?

Answer 3

Depends on underlying cause e.g AMAE

• Smoking
• Hyperlipidaemia
• Hypertension

Question 4

What are the clinical features of acute mesenteric ischaemia?

Answer 4

- Generalised abdominal pain out of proportion to clinical findings

- Pain is diffuse and constant

- N+V

• Non-specific tenderness
• Look for AF or heart murmurs for embolic casue

Question 5

What investigations should be done to diagnose acute mesenteric ischaemia?

Answer 5

• ABG to assess acidosis and serum lactate
• Routine bloods (FBC, U+Es, clotting, amylase, LFTs if coeliac trunk blocked)

- Definitive diagnosis: CT scan with IV contrast

Question 6

Apart from pancreatitis, what can raise serum amylase levels?

Answer 6

• Acute mesenteric ischaemia
• Ectopic pregnancy
• Bowel perforation
• DKA

Question 7

How is acute mesenteric ischaemia managed?

Answer 7

Initial

• Emergency so senior input
• IV fluids, catheter inserted and fluid balance chart

- Broad spectrum abx due to risk of faecal contamination if bowel perforates

- Early ITU input as will have acidosis so at high risk of multi-organ failure

Definitive

- Exicision of necrotic or non-viable bowel if not suitable for revascularisation.

• Revascularisation of the bowel and remove any thrombus or embolism

Question 8

What are some complications with acute mesenteric ischaemia?

Answer 8

• Bowel necrosis
• Bowel perforation
• Mortality 50% even with diagnosis made
• Those that survive may have short gut syndrome

Question 9

What is the pathology of chronic mesenteric ischaemia?

Answer 9

Reduced blood supply to the bowel which decreases over time due to atherosclerosis of coeliac, SMA, IMA

Collateral blood supply of the mesentry means two of the three vessels have to be affected to be symptomatic

Although often asymptomatic, when there is an increased demand for blood supply (after eating or after blood loss) this will exacerbate symptoms

Tends to affect females >60

Question 10

What are some risk factors for chronic mesenteric ischaemia?

Answer 10

• Smoking
• Hypertension
• Diabetes
• Hypercholesterolaemia

Question 11

What are the clinical features of chronic mesenteric ischaemia?

Answer 11

- Post prandial pain: 10mins-4hrs after

- Weight loss: decreased calorie intake and malabsorption

- Concurrent vascular co-morbities: previous stroke, MI

- May have: change in bowel habit loose stools, N+V, malnutrition

- On examination: usually remarkable or generalised abdominal tenderness and abdominal bruits

Question 12

What investigations are done to diagnose chronic mesenteric ischaemia?

Answer 12

- CT angiography for diagnosis

- Blood tests (check FBC, LFTs, U+Es, Mg and Ca due to malnutrition)

- Cardiovascular risk profile (lipid profile, blood glucose)

Question 13

How is chronic mesenteric ischaemia managed?

Answer 13

Conservative

• Modify risk factors to stop propagation e.g stop smoking
• Start anti-platelets and statins

Surgical (severe, progressive disease or debilitating symptoms)

- Endovascular procedures: mesenteric angioplasty with stenting, this is preferred due to general nutritional status of patient

- Open procedures: endartectomy or bypass proedure

Question 14

What are some complications of chronic mesenteric ischaemia?

Answer 14

• Bowel infarction
• Malabsorption
• Concurrent CVS diease