Lightning Learning: Intestinal Ischaemia
Intestinal ischaemia results from decreased blood flow to the GI tract.
Acute mesenteric ischaemia covers a number of presentations: all of which feature reduced blood flow to the intestines, bacterial translocation and an inflammatory response.
Chronic mesenteric ischaemia usually involves all major mesenteric arteries. Colonic ischaemia (most common) arises from blood vessels supplying the colon being affected. Acute intestinal ischaemia has a similar incidence in both men and women. It predominantly affects people over the age of 60 who are at risk of thrombosis (e.g. atrial fibrillation or vasculopaths).
Young people who use substances like cocaine are also at risk as well as those with sickle cell disease.
Intestinal ischaemia presents as poorly localised abdominal pain. It can be colicky in nature or constant. The pain is usually out of proportion to the clinical findings. Peritonism is a late stage finding and may be absent when first seen.
Chronic ischaemia is typically associated with weight loss and postprandial pain as well as a fear of eating. Left iliac fossa pain is often found in patients with colonic ischaemia.
Management of these patients is analgesia, IV fluids and making the patient Nil By Mouth. Urgent surgical opinion should be sought.
Investigations are abdominal pain bloods set as well as lactate. Angiography has been superseded by a contrast CT of the abdomen and pelvis.