Description, Causes and Risk Factors:
Angina abdominis refers to pain or discomfort in the gut when the blood supply to the tissues and organs of digestion has been compromised in some manner, usually due to atherosclerosis in the intestinal and mesenteric vasculature. Although the symptoms can vary from patient-to-patient depending on the extent of vascular compromise, in all cases the patient will consistently experience discomfort during digestion. Left untreated, underlying pathologies can progress, resulting in necrosis of vital abdominal viscera. Sequelae can range from diminished nutrient absorption to systemic sepsis and death.
The most common cause of angina abdominis is atherosclerotic disease of the mesenteric arteries. The blockage usually involves the ostia or the final few proximal centimeters of the mesenteric vessels. Often, aortoiliac disease is also exhibited in the patient with angina abdominis, and can be a cause of lesions of the ostia.
Underlying factors: Digestion increases circulatory demand by the intestines, and when the mesenteric arteries are unable to meet that demand, a state of ischemia develops, resulting in the sensation of pain or angina. If the blood flow continues to be interrupted, the consequence is possible necrosis of the digestive tissues.
Although a recent Pediatric journal describes a 5-year-old boy diagnosed with angina abdominis, the mean age of onset is over 60. This statistic is consistent with the vascular deterioration typically seen in the aging process. Additionally, smoking has been shown to play a key role in the development of angina abdominis. Of patients diagnosed with angina abdominis, a staggering 75-80% are smokers. Another predisposition is hypertension, six of 10 patients who present with angina abdominis will have hypertension. Approximately 82% also have diabetes (type 1 or 2). Hyperlipidemia, often causing peripheral vascular disease (PVD), increases the risk of angina abdominis by 70% and is consistent with the atherosclerotic component of the disease process.
Because angina abdominis can indicate a life-threatening situation, Healthcare providers need to be aware of its implications and be able to recognize its risk factors and symptoms. Early detection increases the treatment options and the possibility of full recovery.
Although symptoms can vary, and usually heighten as the pathology progresses, the initial complaint of the patient experiencing angina abdominis is postprandial pain, generally in the lower abdominal quadrants. Diarrhea is sometimes experienced by those with angina abdominis. This can cause foods to not be digested properly and nutrients to poorly absorb into the body.
Nausea is also often experienced. Consequently, some individuals will vomit, which can sometimes become so severe that it causes issues such as malnutrition due to the inability to keep food down and absorb necessary nutrients. As the disease progresses, small amounts of food in the stomach cause the same amount of pain that large amounts do. Thus, the person begins to experience weight loss. Other symptoms may include aversion to eating, or even fear of eating due to the patient's association of food with pain.
A diagnosis of angina abdominis is considered if postprandial pain or discomfort occurs at a fixed time (typically 15 to 30 minutes) after eating.
Blood tests alone will not be helpful in making a definitive diagnosis-although checking LDL levels may indeed lend validity to such diagnostics because high LDLs are linked to atherosclerosis.
Because the common complaints pertaining to angina abdominis mimic those of several unrelated gastrointestinal (GI) tract issues, it is necessary to examine the patient for such conditions, completely ruling them out first. Strikingly similar in presentation to angina abdominis are gastric ulcers, which may be ruled out by performing an esophagogastroduodenoscopy (EGD). Another important differential is abdominal aortic aneurysms (AAAs). Conducting a CT or MRI angiogram is a conclusive diagnostic tool in determining the existence of AAA. Cancer of the colon or other GI tract organs is also a likely cause of AA-like pain, and requires a diagnostic workup to detect suspected lesions. Angiogram would be the most efficient diagnostic test for angina abdominis.
Other Tests: X-rays, ultrasound, colonoscopy, flexible sigmoidoscopy, in extreme cases, exploratory surgery.
The course of treatment for angina abdominis varies depending on the cause, the affected area, and the extent of tissue damage. For purposes of clarity, the course of treatment can be explained based on the four categories of angina abdominis.
When treating colonic ischemia, antibiotics are often the first line of defense. This will control any infections that have occurred as a result of the condition. Next, treat underlying causes of angina abdominis, such as heart failure, dysrhythmia, hyperlipidemia, or hypertension with medication, diet, or exercise as applicable. Suggest that the patient eat smaller, more frequent meals to relieve digestive load (postprandial discomfort). Also, it will be necessary to treat the patient for any conditions or behaviors that constrict blood flow to digestive vasculature (that is, hyperlipidemia, smoking).
Surgery may be indicated, depending on the extent of the arterial occlusion and tissue damage. If necrosis has occurred, it may be necessary for some tissue to be extracted surgically to prevent further vascular damage. Moreover, if the occlusion is considerable, it may be necessary for the injured artery to be bypassed to restore perfusion.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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