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Abdominal Angina


Presentation

  • Abstract Two cases of verified abdominal angina are presented. Multiple, atypical ulcerations in the postbulbar duodenum were diagnosed endoscopically in both cases. Atypical gastric ulcers were also present in one case.[ncbi.nlm.nih.gov]
  • The purpose of this review is to discuss the pathophysiology and clinical presentation of chronic mesenteric ischemia and to suggest a diagnostic flowchart for this complex condition.[ncbi.nlm.nih.gov]
  • The limited experience in the active management of this, potentially lethal, condition prompted us to present the case of a 54 year old man with an exceedingly rare etiology of mesenteric ischemia.[ncbi.nlm.nih.gov]
  • The authors hereby present a case of TA that presented with abdominal aorta thrombosis.[casereports.bmj.com]
Weight Loss
  • Abstract Abdominal angina is an underrecognized cause of postprandial abdominal pain and weight loss.[ncbi.nlm.nih.gov]
  • Abstract A young man with severe abdominal pain and weight loss due to intestinal ischemia was examined. At operation, the origins of the celiac and superior mesenteric arteries were found to be compressed by plexiform neurofibromatosis.[ncbi.nlm.nih.gov]
  • The pain was chronic, of pressure-like quality, constant but worsened by exertion and mostly by eating resulting in significant unintentional weight loss. A work-up for myocardial infarction, pulmonary embolism and peptic ulcer disease was negative.[shmabstracts.com]
  • Outstanding symptoms include postprandial pain, weight loss, and constipation. Gastrointestinal studies may be negative or may show evidence of impaired intestinal motility, excessive fat in the feces, and occult blood.[jamanetwork.com]
  • Clinically this is characterized by a syndrome having the outstanding features of postprandial abdominal pain, anorexia, weight loss, and eventually infarction of the bowel.[jamanetwork.com]
Coronary Artery Disease
  • In addition other signs of peripheral vascular disease like calf claudications, coronary artery disease, etc may also be present.[tandurust.com]
  • The surgical procedures in the treatment of abdominal angina are not significantly different from that for coronary artery disease (CAD) and a myocardial infarction (heart attack). There are basically three options : Widening the narrowed artery.[healthhype.com]
  • artery disease or heart attack)[my.clevelandclinic.org]
  • The Merck Manual Second Home Edition, Coronary Artery Disease [On-line information]. Available online at . (2001, November, Updated). Angina and Heart Disease. Familydoctor.org [On-line information]. Available online at .[labtestsonline.it]
  • Coronary artery disease (CAD) reduces the flow of blood to your heart.[healthline.com]
Abdominal Pain
  • Abstract Abdominal angina refers to abdominal pain in which perfusion to digestive tissues has been compromised, usually due to mesenteric atherosclerosis. Pathology can progress to necrosis of vital viscera, sepsis, or even death.[ncbi.nlm.nih.gov]
  • Abstract Abdominal angina is an underrecognized cause of postprandial abdominal pain and weight loss.[ncbi.nlm.nih.gov]
  • The classic triad of celiac compression syndrome consists of abdominal pain, an epigastric bruit, and angiographic evidence of celiac compression.[ncbi.nlm.nih.gov]
  • In 36 consecutive patients with a foregut carcinoid with extensive local tumor growth and liver metastases with a carcinoid syndrome, six patients had complaints of postprandial abdominal pain and attacks of subileus based on segmental intestinal ischemia[ncbi.nlm.nih.gov]
  • Abstract The diagnostic value of determining the splanchnic blood flow (SBF) and oxygen uptake before and after a test meal in patients suspected of abdominal angina was investigated in 15 patients with unexplained abdominal pain.[ncbi.nlm.nih.gov]
Constipation
  • Outstanding symptoms include postprandial pain, weight loss, and constipation. Gastrointestinal studies may be negative or may show evidence of impaired intestinal motility, excessive fat in the feces, and occult blood.[jamanetwork.com]
  • Accompanying anxiety symptoms: • Temperature • Leukocytosis – increase of leukocytes in the blood • Nausea and vomiting • Constipation and lack of gas • Peritonizam – hardening of the abdominal wall • haematemesis (vomiting blood) and melena (blood in[myhealth-guide.org]
  • In no particular order, symptoms may include: severe pain or cramping in the abdomen, starting 10-15 minutes after eating and lasting up to 2-3 hours because digestion is delayed nausea vomiting bloating or gas anxiety constipation or diarrhea abdominal[study.com]
Severe Abdominal Pain
  • Abstract A young man with severe abdominal pain and weight loss due to intestinal ischemia was examined. At operation, the origins of the celiac and superior mesenteric arteries were found to be compressed by plexiform neurofibromatosis.[ncbi.nlm.nih.gov]
  • Snap Shot A 70-year-old male with atrial fibrillation presents to the emergency department with sudden onset of severe abdominal pain despite relatively benign findings on physical exam.[medbullets.com]
  • Acute Mesenteric Ischemia often presents with sudden and severe abdominal pain.[diagnose-me.com]
  • abdominal pain, concentrated in one area of the abdomen Nausea and/or vomiting Bloody stools History of chronic atrial fibrillation or cardiovascular disease Chronic Mesenteric Ischemia The organs of the gastrointestinal system are responsible for the[my.clevelandclinic.org]
  • Severe abdominal pain that is disproportionate to examination findings and that responds poorly to analgesia is a classic mode of presentation. A raised lactate or metabolic acidosis can be suggestive lab findings.[radiopaedia.org]
Abdominal Bruit
  • Signs Abdominal bruit (60-90%) Fecal Occult Blood Test ing (10%) VI. Imaging: Diagnosis Angiography (gold standard) MRA Abdomen Ultrasound duplex VII. Management Vascular Surgery Endovascular procedures VIII.[fpnotebook.com]
  • The abdomen is scaphoid and soft and abdominal bruit is present in almost 80% of the patients. In addition other signs of peripheral vascular disease like calf claudications, coronary artery disease, etc may also be present.[tandurust.com]
  • Abdominal bruits are present in 60% to 80% of patients with AA. 3 Also, patients will often show classic signs of PVD, as this is a frequent comorbidity of AA.[journals.lww.com]
Chronic Abdominal Pain
  • Hospice May 20, 2017 (1,400 Views 4 Comments) This is an elderly lady with a complex history autoimmune disorders (SLE headlining), history of acute on chronic abdominal pain without significant findings, one physician queried mesenteric ischemia, and[allnurses.com]
  • […] last authored August 2009, Dave LaPierre Introduction "Chronic abdominal pain is a clinical situation requiring as much tact, diplomacy, and compassion as it does scientific knowledge."[sharinginhealth.ca]
Vascular Disease
  • The most common cause of abdominal angina is atherosclerotic vascular disease, where the occlusive process commonly involves the ostia and the proximal few centimeters of the mesenteric vessels.[parasitetesting.com]
  • Similarly, in textbooks the subject of intra-abdominal vascular disease is usually confined to a discussion of massive mesenteric thrombosis or embolism, with extensive infarction of the intestine, and gangrene and death in a high percentage of cases.[nejm.org]
  • The most common cause of bowelgina is atherosclerotic vascular disease, where the occlusive process commonly involves the ostia and the proximal few centimeters of the mesenteric vessels.[enacademic.com]
Dry Eyes
  • Brand-new chapters cover Ebola , Chikungunya , dry eye , and adolescent health. In addition to current therapy, each chapter also features important diagnostic criteria to ensure delivery of the correct diagnosis and treatment.[books.google.ro]

Workup

  • Hepatitis can be checked initially with a liver function workup. Most likely, an abdominal abscess or appendicitis would be detected during a thorough physical examination and history.[journals.lww.com]
Ischemic Changes
  • Histopathology of the resected small bowel specimens showed elastic vascular sclerosis in three patients and ischemic changes in three other patients, confirming the clinical diagnosis.[ncbi.nlm.nih.gov]

Treatment

  • The surgical treatment led to complete resolution of his symptoms.[ncbi.nlm.nih.gov]
  • Intraluminal stenting for treatment of mesenteric ischemia represents a viable alternative to surgical revascularization in selected cases.[ncbi.nlm.nih.gov]
  • Nevertheless, multi-detector row CT angiography with appropriate postprocessing techniques is highly effective for the diagnosis, evaluation, and treatment of suspected AA.[ncbi.nlm.nih.gov]
  • 32 Neurological Monitoring with Evoked Potentials 401 33 Spinal Cord Ischemia 413 34 Endovascular Treatment of ThoracoAbdominal Aortic Aneurysm with Branched Endografts The NürnbergCleveland Experience 425 35 Endovascular Treatment of ThoracoAbdominal[books.google.ro]
  • The conventional treatment consists of vessels revascularization, but sometimes this is not applicable.[ncbi.nlm.nih.gov]

Prognosis

  • The good longterm results after arterial reconstruction in contrast to the poor prognosis without operation call for early diagnosis and surgical treatment.[ncbi.nlm.nih.gov]
  • Prognosis In cases of mesenteric artery ischemia, prognosis is especially poor if the patient is not treated quickly. Even with treatment the risk of death is 30-90%, depending on the stage at which treatment is started.[diagnose-me.com]
  • Treatment and prognosis If a diagnosis of chronic mesenteric ischemia is made, patients should undergo definitive treatment due to the risk of continued weight loss, acute infarction, perforation, sepsis, or death.[radiopaedia.org]
  • Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 2000;20:1213-24; discussion 1224-6. [ PubMed ] Kernagis LY, Levine MS, Jacobs JE.[qims.amegroups.com]
  • Treatment and prognosis Although treatment will vary according to the severity and cause of the ischemia, in general treatment is surgical. The bowel needs to be assessed for viability and if necrotic needs to be resected.[radiopaedia.org]

Etiology

  • The limited experience in the active management of this, potentially lethal, condition prompted us to present the case of a 54 year old man with an exceedingly rare etiology of mesenteric ischemia.[ncbi.nlm.nih.gov]
  • Less common etiologies include: dissection vasculitis fibromuscular dysplasia radiation cocaine abuse. Chronicity of the symptoms is caused by the gradual decrease in blood flow to the intestines.[radiopaedia.org]
  • The etiology and pathogenesis of vascular disorders of the intestine. Radiol Clin North Am . 2008;46(5):877–885. Keywords: intestinal ischemia ; mesenteric atherosclerosis ; mesenteric ischemia 2010 Lippincott Williams & Wilkins, Inc.[journals.lww.com]
  • The etiology and pathogenesis of vascular disorders of the intestine. Radiol Clin North Am. 2008;46(5):877–885. Keywords: intestinal ischemia ; mesenteric atherosclerosis ; mesenteric ischemia 2010 Lippincott Williams & Wilkins, Inc.[journals.lww.com]
  • The table below summarizes the 4 etiologies of mesenteric ischemia Etiologies of Mesenteric Ischemia Mesenteric Ischemia Types % of Cases Mortality Risk Factors Mesenteric Artery Embolus 50% 70% Arrhythmias Post-myocardial infarction with mural thrombi[cdemcurriculum.com]

Epidemiology

  • It can be associated with: carcinoid [4] aortic coarctation [5] antiphospholipid syndrome [6] Epidemiology [ edit ] Internationally : Extremely rare.[en.wikipedia.org]
  • EPIDEMIOLOGY While several vasculitides may be associated with gastrointestinal involvement, it is most prevalent in patients with immunoglobulin A vasculitis (Henoch-Schönlein purpura), antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis[uptodate.com]
  • Epidemiology Age: 60 years is mean age of diagnosis Gender predominance: Female (by ratio to 3:1) IV.[fpnotebook.com]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • […] before using all of the other population-based studies that have information on both CVD risk factors and questions relating to low-back pain for examining whether these studies give the same results, I would suggest that we use clinical, as well as epidemiologic[sjweh.fi]
Sex distribution
Age distribution

Pathophysiology

  • The purpose of this review is to discuss the pathophysiology and clinical presentation of chronic mesenteric ischemia and to suggest a diagnostic flowchart for this complex condition.[ncbi.nlm.nih.gov]
  • PATHOPHYSIOLOGY The pathophysiology is similar to that seen in angina pectoris and intermittent claudication.[parasitetesting.com]
  • Pathophysiology The pathophysiology is similar to that seen in angina pectoris and intermittent claudication.[ipfs.io]
  • Pathophysiology The pathophysiology is similar to that seen in angina pectoris and intermittent claudication .[enacademic.com]
  • In most series, approximately 75–80% of patients smoke. [ citation needed ] Pathophysiology [ edit ] The pathophysiology is similar to that seen in angina pectoris and intermittent claudication.[en.wikipedia.org]

Prevention

  • Abdominal angina is an early clinical expression of occlusive mesenteric arterial insufficiency, a condition that requires aggressive treatment to prevent intestinal infarction.[ncbi.nlm.nih.gov]
  • If the cause is colonic ischemia, antibiotics are given to control or prevent infections that have resulted from abdominal angina.[epainassist.com]
  • […] and Treatment of Renal Insufficiency 219 19 Prevention and Treatment of Respiratory Insufficiency 229 20 Anesthetic Management of Open ThoracoAbdominal Aortic Procedures The Texas Heart Institute Experience 243 21 Anesthetic Management of ThoracoAbdominal[books.google.ro]
  • Revascularization of the celiac and superior mesenteric arteries by arterial reconstructive procedures is important not only to alleviate symptoms but to prevent mesenteric thrombosis and death.[jamanetwork.com]
  • Unstable angina If you have unstable angina (where symptoms develop unpredictably), you'll need medicines to prevent blood clots and reduce your risk of having a heart attack or stroke.[nhs.uk]

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