What is Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries)?

Mesenteric ischemia is a type of peripheral vascular disease where the blood can’t supply enough nutrients to the internal organs. If it happens suddenly, it’s a serious emergency that can cause severe abdominal pain. This type of pain is often so extreme that it feels much worse than what a physical examination might suggest. However, chronic mesenteric ischemia, which is a long-term condition, often causes unclear abdominal pain. This kind of pain can be hard to tell apart from other common causes of abdominal discomfort.

What Causes Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries)?

Atherosclerosis, which is the hardening of the blood vessels, can be triggered by several factors such as diabetes, high blood pressure, smoking, and high levels of fats in the blood (hyperlipidemia).

Atherosclerosis causes the blood vessels, specifically those in the mesenteric (intestines) region, to narrow. This makes it difficult for blood to flow, especially when the body’s need for blood increases, like during eating. This inadequate blood supply can result in severe abdominal pain and potentially a condition known as mesenteric ischemia, where blood flow to your intestines is reduced.

Risk Factors and Frequency for Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries)

Mesenteric artery stenosis, a condition that affects the arteries in the stomach, is more common among people over 65, with up to 10% experiencing it. However, Chronic Mesenteric Ischemia (CMI) is much rarer and accounts for less than 1 in every 1000 hospital admissions for stomach pain. This condition typically affects people between 50 and 70 years old and is more common in females. Often, these individuals also suffer from other related vascular diseases.

Signs and Symptoms of Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries)

When people experience “intestinal angina,” they’re often dealing with abdominal pain that kicks in about 15 to 30 minutes after eating. This pain can last up to four hours and may cause a fear of eating, leading to weight loss. Along with the abdominal pain, folks may also experience other general symptoms like nausea, vomiting, feeling full early during meals, diarrhea, or constipation. Many patients may have had issues tied to widespread artery disease, like heart-related chest pain, brief stroke-like episodes, or pain and cramping in the lower legs due to poor circulation.

During a physical exam, the abdomen might be lightly tender but without harsh pain or muscle tightness, although in many cases the exam may appear normal. However, a whooshing sound may be heard in the abdomen during the examination in about half of the patients, although this isn’t a reliable sign on its own.

Testing for Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries)

If a person has pain after eating and weight loss, doctors typically rule out common stomach and intestine conditions. These include stomach ulcers, gallbladder inflammation, and cancer. However, this process can delay the diagnosis of a less common condition called Chronic Mesenteric Ischemia (CMI), which is a problem with blood flow to the intestines.

For diagnosing CMI, it’s important to examine the main blood vessels to the intestines, to see if they are narrowed or blocked. A type of computed tomography (CT) scan known as an angiography (CTA) is usually the first choice as it can effectively identify narrowed arteries and rule out other causes of stomach problems.

In a non-hospital environment, a type of ultrasound scan that measures blood flow in the arteries may be used for screening. If the blood flow speed is too fast, it could indicate that the artery is more than 70% narrowed.

If the results from non-invasive scans like CT and ultrasound aren’t clear, doctors may use a special kind of X-ray called digital subtracted angiography (DSA). DSA is considered the gold standard for diagnosing CMI. It not only confirms the diagnosis, but also helps doctors plan treatments.

Treatment Options for Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries)

Patients with Chronic Mesenteric Ischemia (CMI) who show no symptoms are usually treated with a combination of quitting smoking and antiplatelet therapy. However, these patients have a fairly high mortality rate- about 40% within five years, mostly due to heart attack or other heart diseases.

Patients with CMI who do show symptoms should be treated either with a standard surgery or an endovascular procedure. Without treatment, symptomatic CMI is almost always fatal within five years.

There are several situations where surgery becomes necessary:

– Clear signs of inflammation in the abdomen during a physical examination
– Severe bleeding from the lower gastrointestinal tract
– Continued symptoms of abdominal pain, fever, or widespread infection
– Symptoms persisting for more than 14 to 21 days
– Chronic inability to absorb nutrients, leading to protein loss
– Examination of the colon revealing inflammation with open sores
– Existence of a diseased stricture in the colon and abdominal symptoms

Open revascularization, a type of blood flow restoration, can be achieved in a forward (antegrade) or backward (retrograde) flow using either a vein or an artificial conduit. However, endovascular revascularization, which includes balloon angioplasty and stent placement performed through the femoral artery, is the preferred treatment due to its less invasive nature and fewer postoperative complications.

A patient’s nutritional status is a critical factor to evaluate before surgery, as many patients are malnourished during their diagnosis. They may need total parenteral nutrition, i.e., feeding through a vein, both before and after surgery. The best choice between open or endovascular revascularization depends heavily upon a patient’s anatomy and preoperative conditions.

Surgery can lead to complications as these patients generally suffer from widespread atherosclerosis, making them more likely to have a heart attack during or post-surgery. Hence, patients should be well-hydrated and in the best possible health before surgery, with recovery typically taking place in the intensive care unit.

One common postsurgical complication is kidney failure, which can sometimes be permanent. It’s therefore crucial that a kidney specialist sees the patient before surgery. Adequate hydration is the most effective way to avoid kidney dysfunction.

There are several conditions that could be causing your symptoms. These can include:

  • Sudden inflammation of the gallbladder, known as acute cholecystitis
  • Sudden inflammation of the stomach lining, known as acute gastritis
  • A sudden decrease in blood flow to the intestines, known as acute mesenteric ischemia
  • A blockage in your bile ducts, known as biliary obstruction
  • An inflammation of the bile ducts, a condition called cholangitis
  • Long-term inflammation of the stomach lining, known as chronic gastritis
  • A long-term inflammation of the pancreas, referred to as chronic pancreatitis
  • Inflammation in small pockets in your digestive tract, termed diverticulitis
  • Gastric cancer, which is a type of stomach cancer

Your doctor will need to do more tests to figure out the exact cause of your condition.

What to expect with Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries)

Chronic mesenteric ischemia can lead to several complications which include:

* Lowered quality of life

* Fear of eating which can result in malnutrition

* Blood clots causing reduced blood flow to the colon

* Frequent visits to the hospital

* Bleeding in the digestive tract

* Infections

* Long-lasting bowel obstruction

People suffering from chronic mesenteric ischemia often have a poor quality of life due to the fear of experiencing abdominal pain when eating. This fear can lead to significant weight loss and malnutrition. Being malnourished can trigger other health issues like metabolic and hormone problems, weakening of the bones, and bruising easily.

Frequently asked questions

Chronic Mesenteric Ischemia is a long-term condition that causes unclear abdominal pain and is often difficult to distinguish from other common causes of abdominal discomfort.

Chronic Mesenteric Ischemia is much rarer and accounts for less than 1 in every 1000 hospital admissions for stomach pain.

Signs and symptoms of Chronic Mesenteric Ischemia (Poor Blood Supply to the Intestines Due to Blockages of the Arteries) include: - Abdominal pain that occurs 15 to 30 minutes after eating and can last up to four hours. - Fear of eating, leading to weight loss. - Nausea and vomiting. - Feeling full early during meals. - Diarrhea or constipation. - Issues tied to widespread artery disease, such as heart-related chest pain, brief stroke-like episodes, or pain and cramping in the lower legs due to poor circulation. - Light tenderness in the abdomen during a physical exam, but without harsh pain or muscle tightness. - A whooshing sound may be heard in the abdomen during the examination in about half of the patients, although this isn't a reliable sign on its own.

Chronic Mesenteric Ischemia can occur due to blockages of the arteries, specifically the mesenteric arteries, which supply blood to the intestines. These blockages are often caused by atherosclerosis, which is the hardening of the blood vessels. Other factors that can contribute to the development of Chronic Mesenteric Ischemia include diabetes, high blood pressure, smoking, and high levels of fats in the blood (hyperlipidemia).

The doctor needs to rule out the following conditions when diagnosing Chronic Mesenteric Ischemia: - Acute cholecystitis (sudden inflammation of the gallbladder) - Acute gastritis (sudden inflammation of the stomach lining) - Acute mesenteric ischemia (sudden decrease in blood flow to the intestines) - Biliary obstruction (blockage in the bile ducts) - Cholangitis (inflammation of the bile ducts) - Chronic gastritis (long-term inflammation of the stomach lining) - Chronic pancreatitis (long-term inflammation of the pancreas) - Diverticulitis (inflammation in small pockets in the digestive tract) - Gastric cancer (type of stomach cancer)

The types of tests needed for Chronic Mesenteric Ischemia (CMI) include: - Computed tomography angiography (CTA) to examine the main blood vessels to the intestines and identify narrowed arteries. - Ultrasound scan to measure blood flow in the arteries and determine if they are more than 70% narrowed. - Digital subtracted angiography (DSA), a special kind of X-ray, to confirm the diagnosis and help plan treatments. - Physical examination to look for clear signs of inflammation in the abdomen. - Examination of the colon to reveal inflammation, open sores, or a diseased stricture. - Evaluation of a patient's nutritional status before surgery, including total parenteral nutrition if necessary. - Assessment by a kidney specialist to prevent kidney dysfunction, a common postsurgical complication.

Chronic Mesenteric Ischemia (CMI) is treated based on whether the patient shows symptoms or not. Patients without symptoms are typically treated with a combination of quitting smoking and antiplatelet therapy. However, these patients have a high mortality rate of about 40% within five years, mostly due to heart attack or other heart diseases. On the other hand, patients with symptoms of CMI should be treated with either a standard surgery or an endovascular procedure. Without treatment, symptomatic CMI is almost always fatal within five years. The choice between open or endovascular revascularization depends on a patient's anatomy and preoperative conditions. It is important for patients to be well-hydrated and in good health before surgery, as they are more likely to have complications due to widespread atherosclerosis. Adequate hydration is also crucial to avoid kidney dysfunction, a common postsurgical complication.

When treating Chronic Mesenteric Ischemia, there can be several side effects or complications. These include: - High mortality rate (about 40% within five years) for patients with no symptoms, mostly due to heart attack or other heart diseases. - Without treatment, symptomatic CMI is almost always fatal within five years. - Surgery becomes necessary in certain situations such as inflammation in the abdomen, severe bleeding from the lower gastrointestinal tract, persistent symptoms of abdominal pain or infection, chronic inability to absorb nutrients, inflammation with open sores in the colon, and the presence of a diseased stricture in the colon. - Complications from surgery can include heart attack, kidney failure, and postoperative complications. - Patients should be well-hydrated and in good health before surgery, with recovery typically taking place in the intensive care unit. - Adequate hydration is crucial to avoid kidney dysfunction.

The prognosis for Chronic Mesenteric Ischemia is poor, as it can lead to several complications and a lowered quality of life. Some of the complications include malnutrition, blood clots, frequent hospital visits, bleeding in the digestive tract, infections, and long-lasting bowel obstruction. Additionally, the fear of eating due to abdominal pain can result in significant weight loss and malnutrition, which can trigger other health issues.

A vascular surgeon.

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