Overview
Mesenteric ischemia is a condition in which the small intestine's blood flow is restricted due to narrowed or blocked arteries. This reduced blood flow can cause permanent damage to the small intestine. The condition can be acute, developing suddenly due to a blood clot, or chronic, resulting from a buildup of fatty deposits in the arteries (atherosclerosis). Chronic mesenteric ischemia may lead to severe weight loss, malnutrition, and, if left untreated, can become acute. Risk factors for acute mesenteric ischemia include atrial fibrillation, congestive heart failure, and recent vascular surgery, while factors for chronic mesenteric ischemia include type 2 diabetes, high cholesterol, high blood pressure, artery disease, smoking, obesity, older age, and sometimes atherosclerosis. If not treated promptly, acute mesenteric ischemia can result in irreversible bowel damage, sepsis, and death, while chronic mesenteric ischemia can lead to severe weight loss and malnutrition.
Understanding the disease
Symptoms
The symptoms of mesenteric ischemia depend on whether the condition is acute or chronic:
- Acute mesenteric ischemia: symptoms include sudden, severe belly pain, urgent need to have a bowel movement, fever, and nausea and vomiting.
- Chronic mesenteric ischemia: symptoms include belly pain that starts about 30 minutes after eating, pain that worsens over an hour, and pain that goes away within 1 to 3 hours. It is important to note that if you have severe, sudden belly pain that persists, you should seek emergency medical care. If you develop pain after eating, you should make an appointment with your primary care provider.
Risk Factors
The risk factors for developing mesenteric ischemia are: For acute mesenteric ischemia:
- Atrial fibrillation
- Congestive heart failure
- Recent vascular surgery For chronic mesenteric ischemia:
- Type 2 diabetes
- High cholesterol levels
- High blood pressure
- Artery disease
- Smoking
- Obesity
- Older age
Development
Acute mesenteric ischemia usually develops as a result of a blood clot (embolus) that blocks an artery, reducing blood flow to the small intestine. This can be caused by factors such as congestive heart failure, an irregular heartbeat (arrhythmia), or a heart attack. Chronic mesenteric ischemia, on the other hand, is caused by a buildup of fatty deposits (atherosclerosis) in the arteries, which gradually restrict blood flow to the small intestine. Chronic mesenteric ischemia can progress to acute mesenteric ischemia if left untreated or if a blood clot forms within a narrowed artery. Risk factors for both acute and chronic mesenteric ischemia include atrial fibrillation, congestive heart failure, recent vascular surgery, type 2 diabetes, high cholesterol levels, high blood pressure, artery disease, smoking, obesity, and older age. The complications of acute mesenteric ischemia include irreversible bowel damage, sepsis, and death, while chronic mesenteric ischemia can lead to severe weight loss and malnutrition.
Assessment and Diagnosis
Triage
If you have severe, sudden belly pain that persists, you should seek emergency medical care. If you develop pain after eating, you should make an appointment with your primary care provider.
Diagnosis
Diagnosis of mesenteric ischemia typically involves a combination of physical examination, diagnostic tests, and imaging studies. Healthcare providers may consider several factors such as signs and symptoms, blood test results, and imaging findings to confirm the diagnosis. Some of the common diagnostic tests and procedures for mesenteric ischemia include:
- Angiography: A CT scan, MRI, or X-ray of your abdomen may be performed to check for arterial narrowing. Contrast dye can be used to pinpoint areas of arterial narrowing.
- Doppler ultrasound: This noninvasive test uses sound waves to assess blood flow, which can help detect arterial narrowing.
- Blood tests: Although there are no specific blood tests for mesenteric ischemia, general blood test results may suggest the condition, such as an increased white cell count.
- Imaging tests: X-ray, ultrasound, CT scan, or MRI may be used to visualize internal organs and rule out other causes of symptoms. Angiogram or catheter-directed angiogram may be performed to examine blood flow in veins and arteries. It is important to consult a healthcare provider for a thorough evaluation and appropriate diagnostic testing if you suspect mesenteric ischemia.
Management and Treatment
Complications
Potential complications of mesenteric ischemia include irreversible bowel damage, sepsis, and death. Acute mesenteric ischemia can lead to these complications if not treated promptly. Chronic mesenteric ischemia can also cause fear of eating, weight loss, and acute-on-chronic mesenteric ischemia.
Prevention
Prevention of mesenteric ischemia involves addressing its risk factors. Here are some ways to lower the risk of developing mesenteric ischemia:
- Maintain a healthy lifestyle: Eat a balanced diet low in fat, cholesterol, and sodium. Engage in regular physical activity, manage stress, and maintain a healthy weight.
- Manage underlying conditions: Keep your atrial fibrillation, congestive heart failure, and other cardiovascular conditions under control through medications and lifestyle modifications.
- Avoid smoking: Quit smoking to reduce the risk of atherosclerosis and other cardiovascular diseases.
- Control diabetes: Keep your blood sugar levels in check through medications, diet, and exercise to manage type 2 diabetes.
- Treat artery disease: Consult with your healthcare provider about the best treatment options for peripheral artery disease (PAD) or any other artery conditions. Remember that it's essential to consult a healthcare professional for personalized advice and regular check-ups to address any risk factors or symptoms related to mesenteric ischemia.
Treatment
Mesenteric ischemia treatments vary depending on the type and severity of the condition. For acute mesenteric ischemia, immediate treatment is typically required. Surgery is usually the primary treatment option for acute mesenteric ischemia, often involving a procedure called mesenteric angioplasty and stenting. In some cases, an emergency surgery called bowel resection and anastomosis might be performed to remove the damaged section of the intestine and reconnect the healthy parts. Chronic mesenteric ischemia, on the other hand, is treated with either open surgery or a procedure called angioplasty. Angioplasty involves using a balloon catheter to widen a narrowed or blocked artery, often combined with the placement of a stent to keep the artery open. In addition to surgical and medical interventions, lifestyle changes and medications may be recommended to address underlying risk factors and promote overall health. These may include treating underlying conditions like atrial fibrillation, controlling blood sugar levels in people with diabetes, managing high blood pressure, and quitting smoking. It is important to note that the effectiveness of treatments may depend on the specific circumstances of the individual case. Consultation with a medical professional is recommended for proper evaluation and guidance on the most appropriate course of treatment for mesenteric ischemia.
Preparing for medical consultation
To prepare for an appointment for mesenteric ischemia, consider the following:
- Make a list of your symptoms: Record any symptoms you've experienced, including their duration, severity, and any triggers you've noticed.
- Note any pre-appointment restrictions: When you schedule the appointment, ask if there are any specific preparations you need to make, such as fasting before the appointment or avoiding certain medications.
- Gather medical records: Collect your medical history, including any previous surgeries or treatments related to your heart or blood vessels. Bring any relevant imaging or test results to the appointment.
- List current medications: Make a list of any medications, vitamins, supplements, or herbal products you are currently taking.
- Bring a support person: Consider bringing a family member or friend to the appointment to help you remember information, ask questions, and provide emotional support.
- Prepare questions: Write down a list of questions to ask your healthcare provider about your condition, its causes, treatment options, expected outcomes, and any lifestyle changes you may need to make.
- Be prepared to discuss your medical history: Be ready to discuss any other medical conditions you have, previous surgeries, and any medications you are taking. Remember to be open and honest with your healthcare provider about your symptoms and concerns. This will help them provide the best possible care and guidance for your specific situation.