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Mesenteric angina

Definition:
  • A clinical syndrome caused by insufficient blood flow to the intestines due to vascular insufficiency, leading to abdominal pain after meals.
Epidemiology:
  • Commonly seen in the elderly population.
  • Often associated with other forms of atherosclerotic disease.
Pathophysiology:
  • Most often due to atherosclerosis affecting the major mesenteric vessels, particularly the celiac artery and superior mesenteric artery.
  • Reduced blood flow cannot meet the increased demand during digestion, leading to ischemia.
Clinical Presentation:
  • Postprandial abdominal pain: Typically occurs within an hour of eating and can last for several hours.
  • Weight loss: Due to avoidance of eating because of the pain.
  • Non-specific GI symptoms: Nausea, vomiting, and diarrhoea.
Diagnostic Evaluation:
  • CT angiography: Gold standard for visualising vascular occlusions or stenosis.
  • Conventional angiography: Invasive but offers therapeutic opportunities.
  • Blood tests: Often normal but might show signs of malnutrition or malabsorption.
Management:
  • Revascularisation: Surgical bypass or angioplasty and stenting to restore blood flow.
  • Medication: Antiplatelets or anticoagulants to prevent clot formation.
  • Conservative management: Optimising cardiac function and dietary changes to reduce fat which requires more blood for digestion.
Prognosis:
  • Untreated mesenteric angina can progress to mesenteric infarction, a surgical emergency with high mortality.
  • Early diagnosis and intervention improve outcomes.

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