Mesenteric Ischaemia/ischaemic bowel

Question 1

In which type of patients does Mesenteric ischaemia often occur in?

Answer 1

elderly patients

Question 2

what other diseases is Mesenteric ischaemia often associated with?

Answer 2

AF
PVD
chronic cardiac disease

Question 3

what are the common causes of Mesenteric ischaemia?

Answer 3

• athersclerosis
• embolism
• dissection
• external compression by mass lesions
• fibromuscular dysplasia

Question 4

what are the common sites of occlusion in Mesenteric ischaemia?

Answer 4

• splanchnic arteries - superior mesenteric, coeliac arteries and renal arteries.
• bifurcation of the aorta

Question 5

what are the symptoms of an acute Mesenteric ischaemia?

Answer 5

• severe, diffuse abdominal pain

- if involves the renal artery then sudden onset flank pain and haematuria

Question 6

Chronic Mesenteric ischaemia is often asymptomatic unless what?

Answer 6

both the superior mesenteric and coeliac arteries are occluded due to large collateral circulation between these two arterial systems.

Question 7

what is the most common symptom of Mesenteric ischaemia?

Answer 7

intestinal angina - cramping pain typically felt 20-60 minutes after eating.

Question 8

what can intestinal angina be relieved by?

Answer 8

sublingual GTN

Question 9

what other signs/symptoms of Mesenteric ischaemia may be there be?

Answer 9

• weight loss (due to fear to eating)
• abdominal bruit may be heard
• nausea
• vomiting
• diarrhoea
• constipation
• dark stool

Question 10

How is acute Mesenteric ischaemia diagnosed?

Answer 10

usually with a CT of abdomen - sometimes CT angio is also required.

Question 11

What is done to prevent gut necrosis in acute Mesenteric ischaemia?

Answer 11

thrombolysis or percutaneous intervention

Question 12

If gut necrosis if already present in acute Mesenteric ischaemia what is then done?

Answer 12

surgery required to remove affected bowel