Intestinal Angina Symptoms and Treatment Guidelines

Can you get angina in your stomach? How to diagnose intestinal angina? How to treat intestinal angina? Let’s find out about intestinal angina symptoms and treatment!

Intestinal Angina Definition

Intestinal angina meaning – What is intestinal angina? Intestinal angina is abdominal pain caused by less blood flow to the mesenteric artery.

Intestinal angina symptoms and treatment guidelines - intestinal angina diagnosis

Intestinal Angina Causes

What causes intestinal angina? What is the most common cause of intestinal angina? Intestinal angina is caused by thrombosis, which narrows the mesenteric arteries and cuts off blood flow.

Acute mesenteric ischemia is caused by occlusive mesenteric arterial diseases, such as embolic occlusion or primary thrombosis of at least one major mesenteric artery. Ischemia can also be caused by nonocclusive mesenteric ischemia, usually in people with low blood flow, like those with severe heart failure, sepsis, or low blood pressure.

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Chronic mesenteric ischemia, also called intestinal angina, happens when increased flow needs during feeding are not met, causing pain in the abdomen. Because of the rich collateral mesenteric network, at least two of the three major visceral vessels (the celiac, superior mesenteric, and inferior mesenteric arteries) are usually affected before symptoms appear.

Ischemic colitis is a type of mesenteric ischemia that usually occurs where the inferior mesenteric artery runs. The intestinal mucosa is the most sensitive to ischemia and will flake off if it doesn’t get enough blood.

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Intestinal Angina Diagnosis

  • Severe postprandial abdominal pain.
  • “Fear of eating” is a way to lose weight.
  • Acute mesenteric ischemia is characterized by severe abdominal pain but few signs on a physical exam.

Intestinal Angina Symptoms

Signs and symptoms of intestinal angina – What are some symptoms of intestinal angina?

Acute mesenteric ischemia

Visceral arterial embolism is quickly recognized by severe pain in the abdomen. On the other hand, people who have primary visceral arterial thrombosis often have a history of chronic mesenteric ischemia. A key sign of acute mesenteric ischemia is severe, steady, widespread pain in the abdomen, with no tenderness or enlargement in one spot. Ischemia starts in the mucosa and doesn’t affect the peritoneum until transmural ischemia inflames the lining of the peritoneum. This pain is out of proportion to what the physical exam shows. A high number of white blood cells, lactic acidosis, low blood pressure, and a swollen abdomen may help determine what’s wrong.

Chronic mesenteric ischemia

Most patients are older than 45, and they may have signs of atherosclerosis in other blood vessels. Symptoms include pain in the stomach or around the belly button after eating that lasts 1–3 hours. Patients stop eating as much to avoid the pain and may even become afraid of food. Everyone wants to lose weight.

Ischemic colitis

The main symptoms are pain and tenderness in the lower left quadrant, abdominal cramping, and mild diarrhea. The rectal discharge will look like mucus or blood and should cause you to see a doctor.

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Intestinal Angina Treatment and Management Guidelines

Treatment of intestinal angina – What is the best treatment for intestinal angina?

When finding an ischemic intestine, contrast-enhanced CT is very accurate. A CTA or MRA can show that the proximal visceral vessels are getting smaller when a person has acute or chronic mesenteric ischemia. In acute mesenteric ischemia from a state of low flow that is not occlusion, angiography is needed to show that the distal visceral vascular bed looks like a “pruned tree.” When the mesenteric vessels are scanned with ultrasound, proximal obstructing lesions may be seen.

Patients with ischemic colitis should have a flexible sigmoidoscopy to determine how bad the ischemia is. Ischemia is most common in watershed areas like the rectal sigmoid and splenic flexure.

When there is a high chance of acute mesenteric ischemia, the bowel must be checked immediately to see if it is still alive. If the bowel is still alive, an arterial bypass can be done from the supra-celiac aorta or the common iliac artery to the celiac and the superior mesentery artery using a prosthetic conduit. When the viability of the bowel is uncertain or bowel resection is needed, the bypass can be done with a vein from the patient’s body. This is done to avoid using artificial tubes in a field that could be contaminated. Angioplasty and stent placement in the arteries can be used, but this doesn’t eliminate the need for surgery to check if the bowel is still alive.

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Angioplasty and stent placement in the proximal vessel may help with chronic mesenteric ischemia, depending on how the stenosis is formed. If an endovascular solution is impossible, the best treatment is an aorta-visceral artery bypass. The results will last for a long time. Visceral artery endarterectomy is only done when there are multiple lesions, and it would be hard to go around them.

Ischemic colitis is mostly treated by keeping the blood pressure and blood flow up until the collateral circulation is well established. In addition, the patient must be closely watched for signs of perforation that would require resection.

Prognosis

10-15% of people who have surgery end up in the hospital or die. This is partly because people with chronic mesenteric ischemia were malnourished and weak before the surgery.

But if nothing is done, both conditions are always fatal. People with ischemic colitis usually get enough blood flow from other body parts, and the outlook is better than those with chronic mesenteric ischemia.

If a patient is thought to have mesenteric ischemia, they should be sent immediately for imaging and possible treatment.

I hope you understand intestinal angina symptoms and treatment guidelines.

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