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Gastrointestinal Ischemia

What is gastrointestinal ischemia?

When the blood flow to the digestive system is reduced or interrupted, it results in gastrointestinal ischemia. The esophagus, stomach, small intestines, colon (large intestines), and rectum make up the gastrointestinal tract. These organs receive less oxygen when blood flow is reduced, which can cause cell death and long-term organ damage. The most typical kind of gastrointestinal ischemia is colonic.

The celiac artery, superior mesenteric artery, and inferior mesenteric artery are the three branches of the aorta that deliver blood to the gastrointestinal system. The arteries can attempt to make up for obstructions in other regions because the areas that these arteries serve overlap. However, the reduced blood supply will cause more harm to uncompensated tissues.

Risk Factors

Ischemia can be brought on by blood loss, decreased blood flow, artery constriction, or total artery blockage. Arterial narrowing or obstruction can happen as a result of

  • Blood clots
  • Atherosclerosis (hardened arteries caused by fatty deposits called plaques)
  • Cardiovascular disease
  • Aneurysms
  • Tumors
  • Hernias
  • Conditions affecting blood cells or blood vessels
    • Hypercoagulable conditions (increased clotting)
    • Sickle cell anemia
    • Vasculitis
    • Lupus
  • Certain medications
    • Birth control pills
    • Estrogen
    • Migraine medications
  • Drug use
    • Cocaine
    • Methamphetamine

Symptoms

Acute (sudden onset) and chronic gastrointestinal ischemia cause different symptoms. Attacks of acute intestinal ischemia, which are potentially fatal, can occur in people with chronic gastrointestinal ischemia. Surgery must be performed right away for both acute and chronic gastrointestinal ischemia.

Acute Gastrointestinal Ischemia

  • Sudden abdominal pain
  • Nausea
  • Vomiting
  • Fever
  • Bloody stool

There may be frequent bowel movements, no bowel movements, substantial fluid loss into the belly, shock, and other symptoms depending on how long after the ischemia attack started.

Chronic Gastrointestinal Ischemia

  • Abdominal pain or cramps that get worse over time
  • Nausea
  • Vomiting
  • Malnutrition
  • Weight loss
  • Bloody diarrhea

Diagnosis

In addition to the medical history and symptoms, the physician may perform:

  • Abdominal ultrasound
  • CT scan
  • MRI
  • Angiography (X-ray, CT, or MRI with contrast agent to visualize blood vessels)
  • Endoscopy (using a camera to look inside the gastrointestinal tract)
  • Blood tests

Treatments

Depending on what is restricting blood flow, the treatment may differ.  Angioplasty may be used if calcified plaques have formed on the artery walls and are preventing blood flow.  Under x-ray guidance, an angioplasty is carried out by creating a small incision in the groin and advancing a number of tubes and wires to the problematic location.  A balloon can then be used to expand the constricted artery, and a stent may also be implanted.

The strategy is slightly different if a clot has become stuck in an artery and is obstructing flow.  A number of wires and tubes are inserted under the use of x-ray guidance to access the area of concern.  Once the region of concern is located, a specific catheter can be used to access the clot and inject clot-busting drugs to assist dissolve the clot.