Mesenteric Ischaemia

Exam Cram

• Mesenteric ischaemia is caused by narrowing of the arteries supplying small bowel

• Presentation: episodic abdominal pain after meals (bowel angina)

• Diagnosis: CT Angiography- arterial narrowing to small bowel (e.g. SMA)

• Management: statin, BP, lifestyle advice for atheromatous disease

Outline

Background

• Mesenteric ischaemia is comparable to bowel angina

• The GI tract requires significant blood flow for food digestion

• In mesenteric ischaemic there is narrowing of the mesenteric arteries (SMA, IMA, coeliac axis)

• Abdominal pain occurs after meals due to ischaemic because the narrowed arteries cannot supply GI tract's increasing demands

Assessment

Presentation

• Post prandial (after food) abdominal pain

• Background: vasculopath- smoker, previous stroke or ischaemic heart disease

Examination

• Normal

Investigations

• Normal FBC, urea & electrolytes, LFTs, CRP & lactate

• Mesenteric angiogram shows arterial narrowing

Diagnosis

Diagnostic criteria: post prandial abdo pain & CT Angiogram- narrowing of mesenteric arteries

Management

Long term

• Low saturated fat & salt diet

• Statin

• BP control

Resources and References

1. Monita MM, Gonzalez L. Acute Mesenteric Ischemia. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431068/

Written in 2025