Internal Medicine

Circulatory disorder bowel

definition

A circulatory disorder of the intestine is also known as "angina abdominalis" and describes the condition of a reduced blood supply and the resulting insufficient oxygen supply to the intestine. Similar to "angina pectoris", which describes the same condition in the heart and is a symptom of a heart attack, an insufficient supply of the intestines can lead to an "intestinal infarction" if the lack of oxygen is prolonged. In the worst case, the under-supplied tissue dies, which is then no longer able to regenerate completely.

Reason for insufficient oxygen supply (Ischemia) of the intestine is usually a vascular disease that originates in the vascular wall.

This vascular disease reduces the diameter of the vessel and thus the proportion of blood that can reach the organ in the supply area is reduced. This type of insufficient supply is usually a chronic, i.e. long-term process.
A blood clot (thrombus), which was usually formed in other organs. Then the far more acute picture of intestinal ischemia arises, the intestinal infarction, which is very rare but life-threatening.

Causes of circulatory disorders in the intestines

As already indicated, a circulatory disorder of the intestine can be triggered or favored by various factors. On the one hand, the slowly progressing vascular disease plays a decisive role in a high proportion of cases. With this form of the intestinal circulatory disorder, a kind of calcification develops on the vessel walls of the arteries supplying the intestine, which becomes more and more robust. It ensures that the vessel loses its elasticity and its diameter becomes smaller. The disease responsible for this is called "artherosclerosis". It is the most common cause of a heart attack in the coronary arteries.

The calcification of the vessel walls is due to various mechanisms and there are some risk factors that favor the development of the disease. Smoking, high blood pressure, obesity (Obesity), increased blood lipids and diabetes mellitus are some of the best known of these risk factors. A risk factor for atherosclerosis that cannot be influenced is increasing age. The other risk factors can, however, be influenced by lifestyle or medication. In addition to atherosclerosis, a circulatory disorder of the intestine can also result from an occlusion of the blood vessel (embolism). The most common cause of sudden vascular occlusion is blood clots. These usually arise in other organs and are carried to the intestine via the bloodstream. A common place of origin is the left atrium. From here the clot is washed through the large abdominal artery to the intestine, and as the vessels here are getting smaller and smaller, the clot can easily clog a vessel. The areas behind are no longer adequately supplied with blood and oxygen.

The cause of such a clot are, for example, cardiac arrhythmias. In addition to blood clots, the occlusion of an intestinal vessel can also be caused by pieces of tissue (e.g. from tumor tissue) or air. Another but much rarer cause of reduced intestinal blood flow can also be inflammation of the blood vessels (vasculitis). This inflammatory disease is based on autoimmune processes. The antibodies formed by the body's immune system are then directed against the body's own structures, in this case against the vascular wall

Symptoms of a circulatory disorder in the intestines

If one suffers from a circulatory disorder of the gastrointestinal tract that has arisen due to a vascular disease, the symptoms are expressed in a dull, not exactly localizable abdominal pain. These pains tend to occur after meals, when the bowel is very active and therefore needs a large amount of oxygen for digestion.

However, this cannot be sufficiently made available to him due to the reduced blood supply. This leads to digestive disorders and a decreased absorption of nutrients from food. This can result in weight loss in the long term. In the case of an acute intestinal obstruction (caused by a blood clot, for example), the person affected experiences sudden, severe pressure pain in the abdomen, which immediately causes the abdominal wall to defend itself. The pain can be so severe that it can trigger further symptoms such as circulatory disorders, nausea, vomiting and even shock. Since this condition can cause the affected intestinal sections to die off, action should be taken as quickly as possible in this acute form.

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Pain in the bowel

Abdominal pain is a typical symptom of a circulatory disorder in the bowel. Characteristically, the symptoms appear after eating. This phenomenon of pain after eating is known as abdominal angina. As a result, those affected have less appetite and lose weight.

An acute occlusion of an intestinal artery, which rarely occurs, leads to severe abdominal pain with nausea and vomiting. These then initially subside until life-threatening intestinal paralysis and the death of intestinal tissue occur.

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Pain in the bowel
Pain in the small intestine

Inflammation of the intestines with circulatory disorders

Due to the lack of blood circulation and nutrient supply, the intestines can easily become inflamed. In technical terminology, this is called ischemic colitis. Ischemic colitis is associated with cramp-like pain. In addition, those affected suffer from diarrhea and bloody stools. The left bowel loop is most commonly affected. The inflammation should always be treated by a doctor.

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Indolence in the case of circulatory disorders

In the case of chronic intestinal circulatory disorders, the inadequate supply leads to deteriorated bowel function. The small intestine is no longer able to sufficiently digest the pulp and absorb the nutrients. He becomes sluggish and can no longer work properly. Undigested food components get into the large intestine, causing flatulence. The deteriorated bowel function can lead to a variety of digestive problems, such as constipation, but also diarrhea.

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constipation
Flatulence

Therapy of a circulatory disorder in the intestine

Treatment of the two types of intestinal deficiency is different. The acute intestinal infarction due to an obstruction must be treated immediately with an operative intervention, otherwise the affected intestinal section will die. The abdominal wall must be opened and the affected vessel made patency again so that the damage is limited. If this is not possible, the affected section of the intestine is supplied with blood and oxygen again with the help of a bypass operation by diverting another artery. This bridges the supply of the diseased vessel area with a healthy artery.

In the case of insufficient supply, which is slowly progressing through calcification of the arterial wall, the degree of narrowing is first determined. By changing lifestyle, a large group of risk factors can be reduced, and with it the risk of permanent narrowing of the blood vessel. Above all, factors that promote blood circulation have a positive influence. These include movement, for example. With the help of medication, the risk factors of high blood pressure or high blood lipids can be reduced. One drug that should be mentioned here is naftidrofuryl.

If the person concerned is in pain due to the reduced blood flow, the pain should also be treated. In the event of severe constriction by the lime, small interventions can counteract the closure of the vessel. Such procedures are, for example, peeling off the affected vessel or expanding the vessel from the inside. Similar to the heart, the insertion of a wire frame (stent) can be indicated, which ensures that the vessel remains open even after the expansion.

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Circulatory disorders therapy
Medicines for circulatory disorders

Diagnosis of circulatory disorders in the intestines

The doctor makes the diagnosis of a circulatory disorder in the bowel in different ways.
Depending on whether a chronically progressive process such as atherosclerosis or an acutely occurring process such as intestinal obstruction caused by a blood clot is behind it, different symptoms express themselves, which have already been explained in more detail above. Through an intensive conversation (anamnese) the symptoms are determined and the suspicion of a circulatory disorder is confirmed by imaging procedures (e.g. vascular imaging / angiography or an ultrasound examination).

Which doctor treats the circulatory disorder in the intestine?

In the event of an acute circulatory disorder in the intestine (mesenteric infarction), those affected must go to a surgical emergency room as soon as possible.
This is followed by a vascular examination of the abdominal artery and an emergency operation. This is carried out by a vascular surgeon who removes the blockage of the vessel.
If dead parts of the intestine have to be removed, this is usually done by a visceral surgeon (a surgeon for abdominal organs).

In the case of a chronic intestinal circulatory disorder, the extent of the arterial constriction is decisive for therapy. Mild cases can mainly be taken care of by the family doctor, who will refer you to a specialist if the occasion arises. The actual vascular examinations and operations on the vessels are carried out by vascular surgeons.

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