Intestinal Ischaemia (Ischaemic Bowel)

Question 1

what are the three types of bowel Ischaemia

Answer 1

acute mesenteric Ischaemia,

chronic mesenteric ischaemia

colonic ischaemia

Question 2

what is intestinal Ischaemia

Answer 2

obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis

Question 3

aetiology of intestinal ischaemia

Answer 3

embolus (60%) and thrombus (40%)

reasons may be; volvulus, intussusception, bowel strangulation and failed surgical resection

Question 4

risk factors for ischaemic bowel

Answer 4

atrial fibrillation,

endocarditis (can throw an emboli)

arterial/venous thrombosis

Question 5

causes of arterial thrombosis

Answer 5

hypercholesterolaemia,

hypertension,

diabetes mellitus

smoking

Question 6

causes of venous thrombosis

Answer 6

portal hypertension,

splenectomy

Question 7

presenting symptoms of bowel Ischaemia

Answer 7

severe acute colicky pain,

vomitting,

rectal bleeding,

history of heart/ liver disease

diarrhoea,

weight loss

Question 8

signs on physical examination

Answer 8

abdominal bruits, abdominal tenderness and distension

Question 9

what investigations will be done for intestinal ischaemia

Answer 9

CT of the abdomen,

bloods (FBC, LFTs, U&Es, clotting and cross match)

AXR (thickening of small bowel folds and signs of obstruction)

Question 10

what is the most vulnerable site of ischaemia in the bowel

Answer 10

the “waterzone” region;

the area between the supply of the superior and inferior mesenteric arteries - near the splenic flexure

Question 11

how to treat bowel ischaemia

Answer 11

resuscitation and give oxygen

embolectomy or resection of the bowel

give Abx and anticoagulation

Question 12

surgical options

Answer 12

remove the embolism, remove section of the colon, remove the colon.

STOMA