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Medicine (MD/DO)
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First Aid
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First Aid for the USMLE Step 1 (2023)
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Chronic Mesenteric Ischemia

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Chronic Mesenteric Ischemia

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Chronic Mesenteric Ischemia

Crone Mesenteric Ice-Ischemia
DikeHAfifi
10 KEY FACTS
PATHOPHYSIOLOGY
Intestinal Angina
Angel with Abdominal Pain-bolts

Chronic mesenteric ischemia is also known as intestinal angina. It is mentioned as episodic or continuous small intestine hypoperfusion caused by multivessel mesenteric artery occlusion.

Atherosclerosis
Clogged Artery-guy

Chronic mesenteric ischemia is most commonly caused by atherosclerosis in the celiac, superior mesenteric, or inferior mesenteric arteries.

Celiac Artery
Silly-yak Archery-artery

Single-vessel occlusion in chronic mesenteric ischemia is more commonly seen in the celiac artery than in the superior mesenteric artery.

Superior Mesenteric Artery
Super Mouse Archer

The superior mesenteric artery is one of the blood vessels that can be occluded in chronic mesenteric ischemia.

Inferior Mesenteric Artery
In-fur Mouse Archer

The inferior mesenteric artery is one of the blood vessels that can be occluded in chronic mesenteric ischemia.

SIGN AND SYMPTOMS
Postprandial Epigastric Pain
Post-eating E-pick-gas Pain-bolt

Chronic mesenteric ischemia patients most commonly experience epigastric pain in the first hour after eating, which is mentioned as postprandial epigastric pain. It can be described as a dull and crampy pain.

Weight Loss
Skinny-with-baggy-pants

Postprandial epigastric pain will cause patients to avoid eating, known as food aversion or fear. This avoidance will result in weight loss due to the patient's expectation of postprandial pain and other symptoms.

DIAGNOSIS
Angiography
Angel with Angiography

CT angiography of the abdomen and pelvis is the best imaging study for diagnosing chronic mesenteric ischemia because it can exclude other disorders that can induce the same abdominal symptoms. The study can show the presence of stenosis in the major mesenteric vessels.

TREATMENT
Anticoagulation
Ant-tie Clog

Anticoagulation is used to treat the presence of acute thrombus or acute-on-chronic mesenteric ischemia. Vasodilators and antibiotics can be used as adjuvant therapy if indicated in the patient.

Surgery
Surgeon

Revascularization can be open or endovascular. This treatment is used to relieve symptoms, reduce the risk of bowel stricture due to infarction or ischemia, and reverse nutritional depletion and weight loss. Open revascularization includes aortomesenteric or celiac bypass grafting, mesenteric reimplantation, and transaortic endarterectomy. Endovascular options may include balloon angioplasty alone, percutaneous angioplasty and stenting, and retrograde open mesenteric stenting (hybrid technique).

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