Intestinal ischemia in elderly- how common, and should we consider it in screening?
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Intestinal ischemia in elderly- how common, and should we consider it in screening?
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We are all familiar with elderly and sometimes not that elderly patients who have problems with bowel movement, be it constipation and/or diarrhea. Many times we look for possible colorectal cancer or
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Intestinal ischemia in elderly- how common, and should we consider it in screening?
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Intestinal ischemia in elderly- how common, and should we consider it in screening?
posted at 16/6/2012 10:18 PM BST
on bmj.com
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Posts: 1828
First: 7/3/2009 Last: 18/6/2013 |
We are all familiar with elderly and sometimes not that elderly patients who have problems with bowel movement, be it constipation and/or diarrhea. Many times we look for possible colorectal cancer or other causes (metabolic such as diabetes, thyroid functions etc) and find no pathology. On the other hand, we also witness problems of absorption of micro and macroelements in the elderly. Atherosclerosis is a general disease of vasculature. We look for possible ischemic heart disease, possible problems in the peripheral arteries as cause of PVD and we look for cerebral ischemia caused by carotid artery lesions. But, do we miss another silent or semisilent nemesis such as subacute ischemia of bowel due to atherosclerotic changes in mesenteric arteries and/or aorta and /or small vessels of bowel? Is it time to start screening for these? We know it almost always too late with sporadic cases of mesenteric artery osslusion and thrombosis. But these are cases that are on the extreme scale of spectrum. Is it possible that we are missing a large part in the picture and might it be that similar interventions to what we do for PVD can help to improve absorption and bowel movements in elderly? Might it largely be due to ischemic processes overlooked by us?
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Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?
posted at 17/6/2012 11:03 AM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
An interesting post Dr. Yoram. In cases of mesenteric artery osslusion and thrombosis, although not common, it is quite likely that we might have missed them. But another part of it being how should we go for screening in the suspected population & what would exactly mean for the screening, as the methods applied for PVD might not be applicable here. |
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Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?
posted at 17/6/2012 12:53 PM BST
on bmj.com
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Posts: 14
First: 7/9/2011 Last: 24/6/2012 |
The only reliable investigation is Mesenteric Vascular Angiogrphy, which is an interventional procdure and can only be employed in cases with Real suspicion of Ischemia. So it will be a challenge to seek a Test to screen milder cases! Also because of the great vascular supply of the gut (the superior and inferior mesenteric arteries and their pattern of ileal and jejunal branches), it is necessary that the main Trunk of the vessel is involved before any clinical ishemia of the gut develops. So i think thats why we hav'nt thought to screen it as yet.
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Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?
posted at 17/6/2012 1:52 PM BST
on bmj.com
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Posts: 312
First: 2/6/2012 Last: 10/5/2013 |
it usally presant as coliky abdominal pain with diarrhea or haematochezia in early .later gangrene with perforation may occur so recurrent abdominal pain in eldery may be a clue. |
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Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?
posted at 17/6/2012 1:57 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
In Response to Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?: T he only reliable investigation is Mesenteric Vascular Angiogrphy, which is an interventional procdure and can only be employed in cases with Real suspicion of Ischemia. So it will be a challenge to seek a Test to screen milder cases! Also because of the great vascular supply of the gut (the superior and inferior mesenteric arteries and their pattern of ileal and jejunal branches), it is necessary that the main Trunk of the vessel is involved before any clinical ishemia of the gut develops. So i think thats why we hav'nt thought to screen it as yet. Posted by Scalpel Very well said Scalpel, & it shows an introspective review of the discussion. |
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Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?
posted at 17/6/2012 7:30 PM BST
on bmj.com
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Posts: 1828
First: 7/3/2009 Last: 18/6/2013 |
Yes, I am aware about the above mentioned points, however I ask something different:do we see the tip of the iceberg,and there are forms of chronic ischemia that don't present as a full blown chronic mesenteric ischemia, but a milder spectrum? That is , I ask not about CMI and not about mesenteric artery thrombosis, but about subtler forms of ischemia not yet identified completely. Will we find evidence of decreased blood supply in elderly patients who suffer from bowel movement disorders? Maybe the approach of "eat more fiber, drink more, use laxatives or enemas" is actually a symptomatic treatment of something caused by atherosclerosis?
What about high sensitivity ultrasound and duplex as possible screening procedures? |
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Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?
posted at 17/6/2012 8:52 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
In Response to Re: Intestinal ischemia in elderly- how common, and should we consider it in screening?: Yes, I am aware about the above mentioned points, however I ask something different:do we see the tip of the iceberg,and there are forms of chronic ischemia that don't present as a full blown chronic mesenteric ischemia, but a milder spectrum? That is , I ask not about CMI and not about mesenteric artery thrombosis, but about subtler forms of ischemia not yet identified completely. Will we find evidence of decreased blood supply in elderly patients who suffer from bowel movement disorders? Maybe the approach of "eat more fiber, drink more, use laxatives or enemas" is actually a symptomatic treatment of something caused by atherosclerosis? What about high sensitivity ultrasound and duplex as possible screening procedures? Posted by yoram chaiter The point raised by respected Yoram seems clinically important but quite neglected. In many patients there are chances that we miss the subclinical manifestations of generalized atherosclerosis. These forms of ischemia not yet identified completely. We may find evidence of decreased blood supply in elderly patients who suffer from bowel movement disorders, yes surely. And it is quite possible that the approach of "eat more fiber, drink more, use laxatives or enemas" is actually a symptomatic treatment of something caused by atherosclerosis. In those situations the high sensitivity ultrasound and duplex might be very useful screening procedures. Many thanks again for directing the topic discussion to the point. |
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