Mesenteric Ischaemia I

Mesenteric Ischaemia I

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Classification



  • Arterial ischaemia (80%).
  • Venous ischaemia (15%).
  • Non-occlusive mesenteric ischaemia (5%).

Mesenteric Arterial Ischaemia


Severe occlusive disease of at least two of the three mesenteric vessels, resulting in a reduction in blood flow to the gut.


Presentation



  • Chronic.
  • Acute.
  • Acute-on-chronic.

Chronic Mesenteric Ischaemia (CMI)


This is caused by mesenteric artery stenosis (usually at the vessel origin) leading to a chronic or intermittent decrease in mesenteric perfusion. Theoretically, two vessels need to be involved for symptoms to develop (controversial).


Clinical Features


Patients often complain of post-prandial abdominal pain (due to gut malperfusion during digestion) referred to as mesenteric angina. In addition, they may practise food avoidance (due to pain) with weight loss (malabsorption and food avoidance), but can compensate by eating smaller meals more frequently (‘small meal syndrome’). Malabsorption may lead to diarrhoea and steatorrhoea with a risk of vitamin deficiency (especially fat-soluble [A, D, E, K]). Other non-specific features include anorexia, nausea and vomiting.


Investigations and Diagnosis



  • Duplex U/S. Velocity changes may be visualised during the respiratory cycle (dynamic study).
  • Angiography. CTA, MRA or catheter-directed. Mesenteric angiography is the gold standard but it is invasive and best reserved for patients undergoing endovascular treatment.

Treatment

Related posts:

  1. Vascular Investigations: Overview
  2. Raynaud’s and Cold Injury
  3. Peripheral Vascular Injury
  4. Other Aneurysms

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Jul 1, 2016 | Posted by in CARDIOLOGY | Comments Off on Mesenteric Ischaemia I

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