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ANKI GI > [2] Chronic Mesenteric Ischaemia > Flashcards

[2] Chronic Mesenteric Ischaemia Flashcards

1
Q

What is chronic mesenteric ischaemia?

A

A lack of blood supply to the bowel which gradually deteriorates over time as a result of atherosclerosis in the coeliac trunk, superior mesenteric artery, and/or inferior mesenteric artery

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2
Q

What is the pathophysiology of the development of chronic mesenteric ischaemia?

A

The gradual buildup of atherosclerotic plaque causes the narrowing of the blood vessel lumen, reducing blood flow and resulting in ischaemia of the bowel

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3
Q

What is the result of the degree of communication within the visceral blood supply in chronic mesenteric ischaemia?

A

In the majority of circumstances, at least 2 of the CT, SMA, and IMA must be affected

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4
Q

What causes symptom onset in chronic mesenteric ischaemia?

A

When there is increased demand on the blood supply or reduction in blood supply in patients with chronic mesenteric ischaemia a transient ischaemia of the bowel occurs, resulting in symptom onset

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5
Q

What can cause an increased demand on the blood supply to the gut?

A

Eating

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6
Q

What can cause a reduction in blood supply to the gut?

A

Hypovolaemic states

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7
Q

Who does chronic mesenteric ischaemia mostly occur in?

A

Patients >60 yrs

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8
Q

Which gender does chronic mesenteric ischaemia more commonly occur in?

A

Females

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9
Q

Why is chronic mesenteric ischaemia typically under-reported?

A

Because patients with atherosclerotic disease in the mesenteric vessels are often asymptomatic

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10
Q

What is the prevalence of atherosclerotic involvement in the mesenteric vessels?

A

Between 30-50%

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11
Q

What are the main risk factors for chronic mesenteric ischaemia?

A
  • Smoking
  • Hypertension
  • Diabetes mellitus
  • Hypercholesterolaemia
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12
Q

What are the classical symptoms of chronic mesenteric ischaemia?

A
  • Post-prandial pain
  • Weight loss
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13
Q

When does postprandial pain occur in chronic mesenteric ischaemia?

A

Typically around 10mins - 4 hours after eating

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14
Q

What may postprandial pain be associated with?

A

Fear of eating (sitophobia), as eating becomes linked to pain

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15
Q

Why can chronic mesenteric ischaemia lead to weight loss?

A

A combination of decreased calorie intake and malabsorption

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16
Q

What concurrent vascular co-morbidites may be present with chronic mesenteric ischaemia?

A
  • Previous MI
  • Previous stroke
  • PVD
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17
Q

What are the less specific symptoms of chronic mesenteric ischaemia?

A
  • Change in bowel habit (typically loose)
  • Nausea
  • Vomiting
18
Q

What are the examination findings in chronic mesenteric ischaemia?

A

Often non-specific, including;

  • Evidence of malnutrition/cachexia
  • Generalised abdominal tenderness
  • Abdominal bruits
19
Q

What are the differentials for chronic, non-specfiic abdominal pain?

A
  • Chronic pancreatitis
  • Gallstone pathology
  • Peptic ulcer disease
  • Upper GI malignancy
20
Q

What investigations are done in suspected chronic mesenteric ischaemia?

A
  • Routine bloods, including FBC, U&Es, and LFTs
  • CT angiography
21
Q

What may be found on routine bloods in chronic mesenteric ischaemia?

A

They will usually be normal

Cardiovascular risk profile (lipids, glucose) may be abnormal

22
Q

Why is CT angiography useful in the investigation of chronic mesenteric ischaemia?

A
  • Provides good anatomical view of all vessels
  • Can help gauge any intervention required
23
Q

What used to be the gold standard of imaging in chronic mesenteric ischaemia?

A

Catheter angiography, but now used less due to the improvement of CT angiography

24
Q

Who decides on the management plans for chronic mesenteric ischaemia?

A

Typically made jointly between interventional radiologists and vascular surgeons

25
Q

What is involved in the best medical therapy of chronic mesenteric ischaemia?

A
  • Antiplatelet agent
  • Statin
  • Advice promoting weight loss, increasing exercise, and smoking cessation
26
Q

What effect will stabilising the atherosclerotic plaque have in chronic mesenteric ischaemia?

A

It will prevent subsequent worsening of the disease

27
Q

When is surgical intervention warranted in chronic mesenteric ischaemia?

A
  • Severe disease
  • Progressive disease
  • Presence of debilitating symptoms, including weight loss or malabsorption
28
Q

What will the ultimate decision about which surgical approach to take in chronic mesenteric ischaemia depend on?

A
  • Location and severity of disease
  • Patient factors
  • Co-morbidities
29
Q

What are the options for surgical management of chronic mesenteric ischaemia?

A
  • Endovascular procedures
  • Open procedures
30
Q

What is the more common surgical management technique in chronic mesenteric ischaemia?

A

Endovascular procedures

31
Q

What do endovascular procedures consist of in chronic mesenteric ischaemia?

A

Mesenteric angioplasty and stenting

32
Q

What do open procedures in chronic mesenteric ischaemia involve?

A

Endartectomy or bypass procedure

33
Q

How is mesenteric angioplasty performed?

A

Typically percutaneously, through either the femoral artery or brachial/axillary artery, allowing a catheter to be passed to the appropriate vessel under radiological guidance. A small balloon is expanded to dilate the vessel, with any stent deployed if required

34
Q

What is the advantage of mesenteric angioplasty compared to other techniques?

A

It provides a shorter hospital stay with faster mobilisation for the patient

35
Q

What are the main complications of endovascular intervention?

A
  • Haematoma at the arterial punch site
  • Risk of embolisation
  • Vessel perforation
36
Q

What are the main complications of chronic mesenteric ischaemia?

A
  • Bowel infarction with necrosis
  • Malabsorption
37
Q

What is an important consideration when patients present with chronic mesenteric ischaemia?

A

They will likely have concurrent cardiovascular disease, which will also require suitable medical management and optimisation

38
Q

What is the prognosis of chronic mesenteric ischaemia after intervention?

A

Good

39
Q

How does the prognosis of chronic mesenteric ischaemia differ between open surgery and endovascular methods?

A

Comparable results in terms of relief of symptoms

40
Q
A

ANKI GI (43 decks)

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