Mesenteric Ischaemia Flashcards
What is the typical cause of acute mesenteric ischaemia?
An embolism resulting in occlusion of an artery supplying the small bowel, such as the superior mesenteric artery.
A common history includes atrial fibrillation.
What is the typical presentation of abdominal pain in acute mesenteric ischaemia?
Severe, of sudden onset, and out-of-keeping with physical exam findings.
This discrepancy can indicate serious underlying conditions.
What laboratory findings are commonly associated with acute mesenteric ischaemia?
Metabolic acidosis with a raised lactate.
These findings can help in diagnosing the condition.
What is the diagnostic investigation of choice for acute mesenteric ischaemia?
High-resolution computed tomographic (CT) angiography (without oral contrast).
This imaging technique provides detailed vascular information.
What immediate management is usually required for acute mesenteric ischaemia?
Immediate laparotomy, especially if there are signs of advanced ischemia like peritonitis or sepsis.
Delayed surgery is associated with poor prognosis.
What is chronic mesenteric ischaemia primarily caused by?
Atherosclerotic narrowing of mesenteric arteries.
It is most common in elderly patients with cardiovascular risk factors.
What is chronic mesenteric ischaemia often referred to as?
‘Intestinal angina’.
This term reflects the pain experienced after eating.
What are the clinical features of chronic mesenteric ischaemia?
- Postprandial abdominal pain (classically crampy, 30–60 mins after eating)
- Weight loss (due to food avoidance from pain)
- Nausea, bloating, diarrhoea or altered bowel habits
- Abdominal bruit may be heard (not always present)
These features help differentiate chronic mesenteric ischaemia from other conditions.
What is the first-line diagnostic test for chronic mesenteric ischaemia?
CT angiography.
This test is effective in visualizing the blood vessels.
What might duplex ultrasound reveal in cases of chronic mesenteric ischaemia?
Reduced flow in mesenteric vessels.
This can indicate compromised blood supply.
What are common blood test findings in chronic mesenteric ischaemia?
Often normal or show mild anaemia.
Blood tests may not always indicate significant abnormalities.
What management strategies are recommended for chronic mesenteric ischaemia?
- Smoking cessation
- Optimisation of cardiovascular risk factors
- Revascularisation: either endovascular stenting or surgical bypass
- Nutritional support if significant weight loss
Addressing lifestyle factors is crucial in managing the condition.
