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== Causes ==
== Causes ==
Abdominal angina is caused by obstruction or [[stenosis]] of the [[inferior mesenteric artery]] (IMA), [[celiac trunk]], or [[superior mesenteric artery]] (SMA).<ref name="Cademartiri 2004">{{cite journal | last=Cademartiri | first=Filippo | last2=Raaijmakers | first2=Rolf H. J. M. | last3=Kuiper | first3=Jan W. | last4=van Dijk | first4=Lukas C. | last5=Pattynama | first5=Peter M. T. | last6=Krestin | first6=Gabriel P. | title=Multi–Detector Row CT Angiography in Patients with Abdominal Angina | journal=RadioGraphics | volume=24 | issue=4 | date=2004 | issn=0271-5333 | doi=10.1148/rg.244035166 | pages=969–984}}</ref> More than 90% of abdominal angina cases are caused by severe or total stenosis of the splanchnic arteries due to local [[atherosclerosis]].<ref name="van Bockel 2001">{{cite journal | last=van Bockel | first=J.Hajo | last2=Geelkerken | first2=Robert H. | last3=Wasser | first3=Martin N. | title=Chronic splanchnic ischaemia | journal=Best Practice & Research Clinical Gastroenterology | volume=15 | issue=1 | date=2001 | doi=10.1053/bega.2001.0158 | pages=99–119}}</ref> The occlusion mainly affects the ostia or the last few proximal centimetres of the [[mesenteric arteries]].<ref name="Diagnosis and treatment" />
Abdominal angina is caused by obstruction or [[stenosis]] of the [[inferior mesenteric artery]] (IMA), [[celiac trunk]], or [[superior mesenteric artery]] (SMA).<ref name="Cademartiri 2004">{{cite journal | last=Cademartiri | first=Filippo | last2=Raaijmakers | first2=Rolf H. J. M. | last3=Kuiper | first3=Jan W. | last4=van Dijk | first4=Lukas C. | last5=Pattynama | first5=Peter M. T. | last6=Krestin | first6=Gabriel P. | title=Multi–Detector Row CT Angiography in Patients with Abdominal Angina | journal=RadioGraphics | volume=24 | issue=4 | date=2004 | issn=0271-5333 | doi=10.1148/rg.244035166 | pages=969–984}}</ref> More than 90% of abdominal angina cases are caused by severe or total stenosis of the splanchnic arteries due to local [[atherosclerosis]].<ref name="van Bockel 2001">{{cite journal | last=van Bockel | first=J.Hajo | last2=Geelkerken | first2=Robert H. | last3=Wasser | first3=Martin N. | title=Chronic splanchnic ischaemia | journal=Best Practice & Research Clinical Gastroenterology | volume=15 | issue=1 | date=2001 | doi=10.1053/bega.2001.0158 | pages=99–119}}</ref> The occlusion mainly affects the ostia or the last few proximal centimetres of the [[mesenteric arteries]].<ref name="Diagnosis and treatment" />

In rare cases, compression of the celiac trunk by the diaphragm's arcuate ligament can result in isolated occlusive disease (also known as "[[median arcuate ligament syndrome]]").<ref name="Biolato 2009" /> Other less common causes of vascular obstruction include [[vasculitis]], chronic mesenteric [[venous thrombosis]], [[fibromuscular dysplasia]], [[radiation enteritis]], and, in rare cases, extrinsic obstruction or vessel encasement by a tumour.<ref name="Cademartiri 2004" /><ref name="Biolato 2009" />


== Pathophysiology ==
== Pathophysiology ==

Revision as of 19:16, 6 September 2024

Abdominal angina
Other namesIntestinal angina
CT angiogram demonstrating stenosis of the superior mesenteric artery.
SpecialtyGeneral surgery

Abdominal angina is abdominal pain after eating that occurs in individuals with ongoing poor blood supply to their small intestines known as chronic mesenteric ischemia.[1] Although the term angina alone usually denotes angina pectoris (a type of chest pain due to obstruction of the coronary artery), angina by itself can also mean "any spasmodic, choking, or suffocative pain",[2] with an anatomic adjective defining its focus; so, in this case, spasmodic pain in the abdomen. Stedman's Medical Dictionary Online[3] defines abdominal angina as "intermittent abdominal pain, frequently occurring at a fixed time after eating, caused by inadequacy of the mesenteric circulation resulting from arteriosclerosis or other arterial disease. Synonym: intestinal angina."

Signs and symptoms

Symptoms of abdominal angina include postprandial pain, weight loss, diarrhea, nausea, vomiting, and an aversion or fear of eating caused by the pain associated with eating.[4]

Abdominal angina usually starts 30 minutes after eating and lasts for one to three hours. The patient typically expresses the pain as a dull ache by clenching their fist over the epigastrium (the abdominal Levine sign).[5]

Patients who restrict their own food intake to prevent the pain of abdominal angina typically present with weight loss. Additionally, patients may experience changes in their bowel habits, most commonly diarrhea from malabsorption (which leads to weight loss) or less frequently constipation.[5]

Causes

Abdominal angina is caused by obstruction or stenosis of the inferior mesenteric artery (IMA), celiac trunk, or superior mesenteric artery (SMA).[6] More than 90% of abdominal angina cases are caused by severe or total stenosis of the splanchnic arteries due to local atherosclerosis.[7] The occlusion mainly affects the ostia or the last few proximal centimetres of the mesenteric arteries.[4]

In rare cases, compression of the celiac trunk by the diaphragm's arcuate ligament can result in isolated occlusive disease (also known as "median arcuate ligament syndrome").[5] Other less common causes of vascular obstruction include vasculitis, chronic mesenteric venous thrombosis, fibromuscular dysplasia, radiation enteritis, and, in rare cases, extrinsic obstruction or vessel encasement by a tumour.[6][5]

Pathophysiology

The pathophysiology is similar to that seen in angina pectoris and intermittent claudication. 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.[citation needed] It can be associated with:

Treatment

Stents have been used in the treatment of abdominal angina.[11][12]

See also

References

  1. ^ Kapadia S, Parakh R, Grover T, Agarwal S (2005). "Side-to-side aorto-mesenteric anastomosis for management of abdominal angina". Indian Journal of Gastroenterology. 24 (6): 256–7. PMID 16424623.
  2. ^ Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
  3. ^ Wolters Kluwer, Stedman's Medical Dictionary, Wolters Kluwer.
  4. ^ a b Tyson, Rev. Dr. Ronald Lee (2010). "Diagnosis and treatment of abdominal angina". The Nurse Practitioner. 35 (11): 16–22. doi:10.1097/01.NPR.0000388938.08875.99. ISSN 0361-1817. PMID 20935581.
  5. ^ a b c d Biolato, Marco; Miele, Luca; Gasbarrini, Giovanni; Grieco, Antonio (2009). "Abdominal Angina". The American Journal of the Medical Sciences. 338 (5): 389–395. doi:10.1097/MAJ.0b013e3181a85c3b.
  6. ^ a b Cademartiri, Filippo; Raaijmakers, Rolf H. J. M.; Kuiper, Jan W.; van Dijk, Lukas C.; Pattynama, Peter M. T.; Krestin, Gabriel P. (2004). "Multi–Detector Row CT Angiography in Patients with Abdominal Angina". RadioGraphics. 24 (4): 969–984. doi:10.1148/rg.244035166. ISSN 0271-5333.
  7. ^ van Bockel, J.Hajo; Geelkerken, Robert H.; Wasser, Martin N. (2001). "Chronic splanchnic ischaemia". Best Practice & Research Clinical Gastroenterology. 15 (1): 99–119. doi:10.1053/bega.2001.0158.
  8. ^ deVries H, Wijffels RT, Willemse PH, et al. (2005). "Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology". World Journal of Surgery. 29 (9): 1139–42. doi:10.1007/s00268-005-7825-x. PMID 16086212. S2CID 5949030.
  9. ^ Ingu A, Morikawa M, Fuse S, Abe T (2003). "Acute occlusion of a simple aortic coarctation presenting as abdominal angina". Pediatric Cardiology. 24 (5): 488–9. doi:10.1007/s00246-002-0381-3. PMID 14627320. S2CID 12638082.
  10. ^ Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS (2002). "Primary antiphospholipid syndrome presenting with abdominal angina and splenic infarction". Rheumatol. Int. 22 (3): 119–21. doi:10.1007/s00296-002-0196-9. PMID 12111088. S2CID 22613047.
  11. ^ Senechal Q, Massoni JM, Laurian C, Pernes JM (2001). "Transient relief of abdominal angina by Wallstent placement into an occluded superior mesenteric artery". The Journal of Cardiovascular Surgery. 42 (1): 101–5. PMID 11292915.
  12. ^ Busquet J (1997). "Intravascular stenting in the superior mesenteric artery for chronic abdominal angina". Journal of Endovascular Surgery. 4 (4): 380–4. doi:10.1583/1074-6218(1997)004<0380:ISITSM>2.0.CO;2. ISSN 1074-6218. PMID 9418203.

Further reading

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