Intestinal Ischemia

Question 1

Define intestinal Ischemia

Answer 1

Range of conditions characterised by reduced blood flow to the intestine

Can be chronic and reversible or acute/fulgurant

usually separated by area affected (by artery)
Acute/Chronic mesenteric ischemia
Colon Ischemia (more common)

Question 2

Aetiology and risk factors of intestinal Ischemia

Answer 2

Aetiologies can be occlusive or non occlusive
occlusive-
or Arterial compromise vs venous

Arterial:
embolism (50% of acute)-usually left ventricle thrombus
thrombosis-acute-progression from atherosclerosis
Vasculitis (RA, etc)
External compression-tumours etc

Venous
Thrombosis -5% of acute -associated with portent HTN

Hypoperfusion-20% of acute-> from shock, hypotension–heart failure, dialysis, drug related, trauma

Risk factors
Any atherosclerosis factors (age, smoking, fat, DM
Older
co-morbidities
Hypercoagulable states
AF
MI
Hx of vasculitis
surgery
cancer
constipation

Question 3

Epidiemology of intestinal ischemia

Answer 3

9 in 100000 in older people

Question 4

Signs and Sx of intestinal ischemia

Answer 4

Most common-abdominal pain

Very common-malena/bright red blood (think also infective or IBD)
Diarrhoae
weight loss
abdo Bruits and tenderness

Anemia
reduced appetite in chronic cases

DRE–> blood on fingers

Question 5

Investigations of intestinal ischamia

Answer 5

FBC-aneamia
acute tend to have leukocytosis
Acidosis (from lactate)-occurs late into acute event

Sigmoidoscopy-tell between ischemic and infective (and IBD)

Then work on cause-
Coagulation screen
ECG
CXR-free air if peroration
Abdo CT