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Intestinal ischaemia

Medicine > Cardiovascular

Background Knowledge 🧠

Definition

  • A condition characterised by reduced blood flow to the intestines, leading to tissue damage and potentially cell death.

Aetiology/Causes

  • Arterial embolism, commonly originating from the heart (e.g., atrial fibrillation).
  • Arterial thrombosis in existing atherosclerotic vessels.
  • Nonocclusive mesenteric ischaemia: Resulting from low blood flow states such as shock or heart failure.
  • Venous thrombosis, often due to hypercoagulable states or inflammation.

Clinical Features 🌡️

Clinical Presentation

  • Sudden onset of severe abdominal pain, often out of proportion to physical findings.
  • Initial pain may be colicky, progressing to a constant pain.
  • Nausea, vomiting, and diarrhoea.
  • Later stages: Bloody stools, signs of peritonitis, and septic shock.

Differential Diagnoses

  • Acute pancreatitis
  • Peptic ulcer disease
  • Cholecystitis
  • Diverticulitis

Investigations 🧪

Investigations

  • Lactate level: Elevated in ischaemic conditions.
  • Full Blood Count (FBC): Leucocytosis suggesting inflammation or infection.
  • CT angiography: Gold standard for visualising blood flow in mesenteric vessels.
  • Doppler ultrasound: Useful for assessing blood flow.
  • Plain X-rays: May show signs of bowel obstruction or pneumatosis intestinalis (air within the bowel wall).

Management 🥼

Management

  • Immediate resuscitation with fluids and correction of any electrolyte imbalances.
  • Surgical intervention to restore blood flow, resect necrotic bowel, and prevent or treat complications.
  • Anticoagulation in venous thrombosis cases.
  • Antibiotics to prevent or treat secondary infections.

Complications

  • Peritonitis: Inflammation of the inner lining of the abdominal wall.
  • Septic shock: Severe drop in blood pressure due to a widespread infection.
  • Short bowel syndrome: Resulting from extensive resection of the intestines.
  • Multiple organ dysfunction syndrome (MODS).

Key points

  • Intestinal ischaemia is characterised by a reduction in blood flow to the intestines.
  • Causes include arterial embolism, arterial thrombus and nonocclusive mesenteric ischaemia (e.g., shock).
  • Patients typically present with sudden onset severe abdominal pain, nausea, diarrhoea and vomiting.
  • Patients require supportive care including immediate resuscitation with fluids. In severe cases, surgical intervention may be required.

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Cardiovascular