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Mesenteric Ischaemia

#MesentericIschaemia #AbdominalPain #BlockedArteries #BloodClots #Atherosclerosis #VascularSurgeon #Diagnosis #Treatment #Angiogram #Stenting #Thrombolysis This video transcript from Dr Gregory Weir's channel explains *mesenteric ischaemia**, a condition involving **poor circulation in the arteries supplying blood to the abdominal organs**, including the stomach, liver, and colon. This can lead to significant **abdominal pain* and compromise organ function due to a lack of oxygen-rich blood. Mesenteric ischaemia can manifest *suddenly (acute)* or develop **slowly (chronic)**. *Acute mesenteric ischaemia* often presents with *sudden, severe stomach pain**, sometimes accompanied by nausea or vomiting. A common cause is a **blood clot* that travels to the mesenteric arteries, often originating from the heart in patients with irregular heartbeat or heart disease. *Chronic mesenteric ischaemia* typically causes *severe stomach pain 15 to 60 minutes after eating**, lasting up to two hours and recurring with meals. Patients may also experience nausea, vomiting, diarrhoea, or flatulence and sometimes suffer **weight loss* due to avoiding food to prevent pain. Chronic mesenteric ischaemia is frequently due to **atherosclerosis**, the **hardening and narrowing of the blood vessels**. Diagnosis involves a consultation with a **vascular surgeon**, who will inquire about medical history (smoking, high blood pressure, diabetes, heart disease) and the specifics of the symptoms. A physical examination will be performed, and investigations may include **sonar (arterial duplex Doppler of the abdomen), CT angiogram (the test of choice for detailed 3D imaging), or a formal angiogram**. Angiography, while more invasive, allows for rapid diagnosis and potential immediate intervention. The primary *goal of treatment* for both acute and chronic mesenteric ischaemia is to *restore adequate blood flow* to the abdominal organs before permanent damage occurs. In acute cases, pain medication may be administered, and emergency treatment is usually required. If a clot is detected early, *thrombolytic therapy (clot-dissolving medication)* may be used, often during the diagnostic angiogram. Surgery to remove the clot or damaged portions of the intestine might be necessary. For *chronic mesenteric ischaemia**, minimally invasive **endovascular treatment**, such as **balloon angioplasty and stenting**, has become the first-line approach, sometimes performed during the diagnostic angiogram. A **stent**, a metallic mesh tube, supports the widened artery to keep it open. Post-treatment, maintaining a healthy **low cholesterol diet, avoiding smoking, regular exercise, hydration, and managing chronic conditions* are crucial. Overview of acute and chronic mesenteric ischeamia. Short case presentation of patient with stenosed superior mesenteric artery.