Mesenteric Ischaemia/ Upper GI Bleeding

Question 1

What is Acute mesenteric ischaemia?

Suggest 3 groups of people who its more common in

Answer 1

Reduced blood supply to GI tract

• Females
• History of peripheral vascular disease
• Elderly patients with cardiovascular risk factors

Question 2

What are 3 types of causes of acute mesenteric ischaemia

Answer 2

• Acute Occlusion (50% Arterial embolism in SMA)
• Non occlusive mesenteric Ischaemia (Low CO)
• Mesenteric venous thrombosis (Malignancy, systemic coagulopathy)

Question 3

List some symptoms of Acute Mesenteric Ischaemia

Answer 3

• Ab pain (30mins after food, lasts 4 hours)
• Nausea + Vomiting
• Pain often left sided, as Splenic Flexure is most fragile

(Splenic flexure- where transverse-> Descending colon)

Question 4

What are 3 investigations for Acute Mesenteric Ischaemia?

Answer 4

• Blood tests (Metabolic acidosis, increases lactate)
• Erect CXR (check for perforation)
• CT Angiography (IV Contrast)

Question 5

How is Acute Mesenteric Ischaemia treated?

Answer 5

• Surgery (Removal of ischaemic bowel/ Bypass graft)

- Thrombolysis/ angioplasty

Question 6

What causes 20-50% of Upper GI Bleeding?

Where are these most common?
What vessel lies near here?

Answer 6

Peptic Ulceration

• Duodenal ulcers most common
• Gastroduodenal artery lies behind proximal duodenum

(Gastric ulcers tend to be on Antrum and Lesser Curve)

Question 7

What causes 12-14% of Upper GI Bleeding?

Answer 7

Oesophageal varices

Question 8

Describe the Portal and Systemic drainage of the Oesophagal veins

Answer 8

Portal;
- Oesophgaeal veins-> Left gastric vein-> Portal vein

Systemic;
- Oesophgeal veins-> Azygous vein-> SVC

Question 9

How are Oesophgeal Varices treated?

Answer 9

• Putting bands around base of varices to stop bleeding

TIPS (Transjugular Intrahepatic Portosystemic Shunt);
- Metal stent placed within liver, connecting Portal to Hepatic Veins, reducing Portal Vein pressure

• Terlipressin reduces Portal vein pressure