Ischaemia to the Lower GI Tract

Question 1

3 Types: Ischaemia to the Lower GI Tract

Answer 1

Acute Mesenteric Ischaemia
Chronic Mesenteric Ischaemia
Ischaemic Colitis

Question 2

Ischaemia to the Lower GI Tract Common Predisposing Factors:

Answer 2

Increasing age, Atrical Fibrillation - mesenteric
Emboli - endocarditis, malignancy
Cardiovascular disease risk factors - smoking, hypertension, diabetes
Cocaine, ischaemic colitis is sometimes seen in young cocaine users.

Question 3

Acute Mesenteric Ischaemia:

Answer 3

Caused by an embolism resulting in occlusion of an artery which supplies the small bowel, - for example the superior mesenteric artery.

Question 4

Acute Mesenteric Ischaemia: Typical patient

Answer 4

history of AF
Severe abdominal pain
Sudden onset
Out-of-keeping with physical exam findings

Question 5

Acute Mesenteric Ischaemia: Investigation

Answer 5

Serum Lactate - first line

Question 6

Acute Mesenteric Ischaemia: Management

Answer 6

Urgent surgery is usually required - there is a poor prognosis, especially if surgery is delayed

Question 7

Chronic Mesenteric Ischaemia

Answer 7

Rare clinical diagnosis due to its non-specific features and may be though of as “intestinal angina”. Triad of Colickly, intermittent abdominal pain, weight loss, and abdomonal bruits.

Question 8

Ischaemic Colitis

Answer 8

Acute but transient compromise in blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage. It is more likely to occur in watershed areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

Question 9

Ischaemic Colitis Investigations

Answer 9

Abdominal X Ray - thumb printing - may be seen due to mucosal oedema/haemorrhage.

Question 10

Mesenteric Ischaemia points:

Answer 10

Typically small bowel
Due to embolism 
Sudden onset
Severe symptoms
Urgent surgery
High mortality 
- ischaemia to lower GI tract
-abdominal pain
Usually supportive management

Question 11

Ischaemic Colitis points

Answer 11

Large bowel
Multifactorial
Transient 
Less severe symptoms
Bloody diarrhoea 
Thumb printing
Conservative management
- ischaemia to lower GI tract
-abdominal pain