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Abdominal angina

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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

Enhanced computed tomography showing severe atherosclerosis of the arteries. The aorta shows broad calcifications, and the celiac artery shows moderate stenosis, although the lumen of the superior mesenteric artery was relatively patent. In addition, stenosis of the inferior mesenteric artery was very severe.

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]

Risk factors

Gender appears to play a crucial effect in the development of abdominal angina. Women are threefold more likely to develop abdominal angina than men. Age also plays a role. The average age of onset is more than 60.3 This data corresponds with the vascular damage that occurs during the aging process. Furthermore, smoking has been demonstrated to play an important function in the development of abdominal angina. Smokers account for 75% to 80% of all abdominal angina cases. Hypertension is another known risk factor. Six out of ten patients with abdominal angina will be hypertensive. Approximately 82% have diabetes. Hyperlipidemia, which frequently causes peripheral vascular disease, raises the risk of abdominal angina by 70% and correlates with the atherosclerotic aspect of the disease process.[4]

Mechanisms

The celiac, superior mesenteric, and inferior mesenteric arteries are the three primary blood vessels that support the digestive tract. Abdominal pain, the hallmark of abdominal angina symptomatology, happens because the digestive processes require increased blood flow to the stomach. The stenotic or occluded artery cannot give adequate flow. The pain is caused by ischemia of the affected tissues, which do not receive the essential perfusion to carry on digestion.[4]

Treatment

Stents have been used in the treatment of abdominal angina.[8][9]

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 c d 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. PMID 19794303.
  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. PMID 15256621.
  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. PMID 11355903.
  8. ^ 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.
  9. ^ 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 (inactive 2024-09-06). ISSN 1074-6218. PMID 9418203.{{cite journal}}: CS1 maint: DOI inactive as of September 2024 (link)

Further reading

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