Intestinal ischaemia Flashcards
Coeliac artery supplies
Foregut
- stomach
- part of the duodenum
- biliary system
- liver
- pancreas
- spleen
Super mesenteric supplies
Midgut
- distal part of duodenum to first half of transverse colon
Inferior mesenteric supplies
Hindgut
- second half of transverse colon to the rectum
Common predisposing features in bowel ischaemia
Increasing age
AF
Other causes of emboli (endocarditis, malignancy)
CVD risk factors (smoking, HTN, diabetes etc)
Cocaine (particularly in younger patients)
Common features of bowel ischaemia
Abdo pain (sudden onset in acute, colicky after eating in chronic)
Rectal bleeding
Diarrhoea
Fever
Lactic acidosis
Weight loss in chronic
Diagnosis
Contrast CT scan
Cause of acute mesenteric ischaemia
Usually embolism resulting in occlusion of an artery supplying the small bowel
Management of acute mesenteric ischaemia
Urgent surgery usually required
Remove necrotic bowel, remove/ bypass thrombus
Poor prognosis, especially if surgery delayed
Chronic mesenteric ischaemia
Also called intestinal angina
Result of narrowing of mesenteric blood vessels
Similar to pathophysiology of angina
Triad for chronic mesenteric ischaemia
Central colicky abdo pain after eating
Weight loss
Abdominal bruit
Management of chronic mesenteric ischaemia
Reduce modifiable risk factors
Secondary prevention (statins and antiplatelets)
Revascularisation to improve blood flow
Revascularisation
Endovascular procedures first-line (percutaneous mesenteric artery stenting)
Open surgery (i.e. endarterectomy, re-implantation of bypass grafting)
Ischaemic colitis
Acute but transient compromise in blood flow to large bowel
Leads to ulceration, inflammation and haemorrhage
Most common areas for ischaemia colitis
‘Watershed’ areas e.g. splenic flexure
Located at borders of the territory supplied by superior and inferior mesenteric arteries
Xray of ischaemic colitis
‘Thumbpriniting’ on abdo xray due to mucosal oedema/ haemorrhage
