Mesenteric Ischaemia Flashcards
What is acute mesenteric ischaemia?
Sudden decrease in blood supply to bowel > bowel ischaemia > death
Causes of mesenteric ischaemia
- embolism (most common)
- thrombus in situ
- non-occlusive cause (low CO)
- venous occlusion + congestion
Risk factors of acute mesenteric ischaemia
- smoking
- Hyperlipidaemia
- hypertension
- AF
Presentation of acute mesenteric ischaemia
- generalised abdominal pain
- often left sided due to location in splenic flexure
- pain out of proportion to clinical findings
- N+V
Investigations of acute mesenteric ischaemia
- ABG
- routine bloods
- CT angiogram
What is first line imaging for acute mesenteric ischaemia?
CT angiography
Features of acute mesenteric ischaemia on CT scan
- oedematous bowel initally
- then loss of bowel enchantment + pneumatosis
ABG in acute mesenteric ischaemia
Metabolic acidosis
Raised lactate
Management of acute mesenteric ischaemia
- surgical emergency
- urgent resuscitation
- broad spec abx
- excision of necrotic or non viable bowel
- re vascularisation of bowel - angioplasty to remove thrombus
Complications of acute mesenteric ischaemia
- bowel necrosis
- bowel perforation
- mortality 50%+
Where is acute mesenteric ischaemia most likely to occur?
Splenic flexure
(Watershed area)
What is chronic mesenteric ischaemia caused by?
Narrowing of mesenteric blood vessels due to atherosclerosis
Risk factors of chronic mesenteric ischaemia
- smoking
- diabetes mellitus
- hypertension
- increasing age
- obesity
- Hyperlipidaemia
Presentation of chronic mesenteric ischaemia
Classic triad:
- weight loss
- central colicky abdominal pain 30 mins after eating (postprandial pain)
- abdominal bruit (possible)
Imaging of choice for chronic mesenteric ischaemia
CT angiography
What specific electrolytes should be checked in chronic mesenteric ischaemia + why?
Magnesium + calcium
Due to malnutrition
Management of chronic mesenteric ischaemia
- modify risk factors e.g. smoking cessation, anti-platelets + statins
- endovascular procedures first line - percutaneous mesenteric artery stenting
- open surgery second line: bypass or endartectomy
Complications of chronic mesenteric ischaemia
- bowel infarction
- malabsorption
