Abdominal angina (patient information)

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 * ; Mohammed Sbeih, M.D.; Assistant Editor-In-Chief: Meagan Doherty, B.S.

Overview
Abdominal angina is postprandial abdominal pain that occurs in individuals with insufficient blood flow to meet mesenteric visceral demands. It is rare and smoking may increase the risk of getting this disorder. Usual signs and symptoms include abdominal pain, nausea or vomiting, diarrhea or constipation, and bloating. Biplane aortography is the criterion standard test for the diagnosis of abdominal angina. Duplex ultrasonographic examination and abdominal MRI may also supply helpful information for diagnosis. Patients without symptoms of andominal angina do not constitute an indication for treatment. For patients of abdominal angina with symptoms, surgery is the main treatment to relieve the symptoms and prevent intestinal infarction. There is no effective medical therapy exists for this disorder. Prognosis depends on whether the patient is treated by early surgery and whether complications such as access site hematoma, pseudoaneurysm or thrombosis appear.

What are the symptoms of abdominal angina?

 * Abdominal pain: The classic pain is located in midepigastric or central, develops 10-15 minutes after eating. Some pain may described as cramplike or a dull ache and be poorly localized.
 * Diarrhea or constipation
 * Bloating
 * Vomiting

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

What causes abdominal angina?
Insufficient blood flow to meet mesenteric visceral demands, especialy after meals.

Who is at risk for abdominal angina?
Abdominal angina is extremely rare, and epidemiological studies show it may be associated with the following factors.
 * Smoking: Clinical data show that approximately 75-80% of patients smoke.
 * Age: Age older than 60 years increases the risk of getting abdominal angina.
 * Sex: Females outnumber males by approximately 3 to 1.
 * Race: No data demonatrates the relationship between race and the incidence of abdominal angina.

Diagnosis
Imaging studies are needed to identify the diagnosis.
 * Biplane aortography: It is the criterion standard test for the diagnosis of abdominal angina. Further more, it can help plan the operative approach. A lateral aortogram can show abrupt cutoffs at the origin of the visceral vessels, a tapered occlusion of the distal aorta and a meandering mesenteric artery.
 * Duplex ultrasonographic examination: This painless test uses sound waves to create a picture of the internal organs. It is a useful screening modality, especially in patients in whom the diagnosis is suspected. Angiography is recommended if the result of duplex ultrasonographic examination is positive.
 * MRI: An MRI uses magnetic fields to built images and can produce detailed information of the body. It has been used as an alternative to aortography in patients who have contrast sensitivity or who are at risk for contrast-related renal dysfunction. It can help diagnosis by delineating the anatomy. Also, it can be used to study metabolic parameters.

When to seek urgent medical care?
Call your health care provider if you suffer from the symptoms of abdominal angina.

Treatment options
The most common indication for treatment of abdominal angina is the presence of symptoms related to intestinal ischemia. Patients without symptoms do not constitute an indication for treatment. The main treatment for patients with abdominal angina is surgery.


 * Surgery: The goal of surgery is to relieve the symptoms of abdominal angina and prevent intestinal infarction. Usual types of surgery include thrombectomy (removal of the obstructing lesion) and/or bypass of the obstructed portion of the blood vessel with an endogenous or prosthetic vascular conduit.
 * Endovascular surgery: During this procedure, an aortogram is performed at first. After the narrowed artery is identified, the doctor uses a guide wire across the narrowed portion of the artery under direct fluoroscopy, dilating the narrow portion by a balloon. If residual stenosis is more than 50% of the expected artery luminal, a stent is recommended to place a stent across the narrowed portion of the blood vessel.
 * Open surgery: This kind of surgery is appropriate for patients whose lesions are not amenable to endovascular management. Under general anesthesia, the arteriotomy is performed to the patient to open the artery, then followed by embolectomy and removal of atherosclerotic plaques.


 * Medications: There is no effective medical therapy exists.

Diseases with similar symptoms

 * Gastrointestinal cancer, such as stomach cancer, gallbladder cancer or colorectal cancer.

Where to find medical care for abdominal angina?
Directions to Hospitals Treating abdominal angina

Prevention of abdominal angina
Stop smoking may be an effective measure for the prevention of abdominal angina.

What to expect (Outlook/Prognosis)?
The prognosis of abdominal angina depends on the following:
 * Whether the patient is treated by early surgery.
 * Whether reocclusion happens or not
 * Whether complications such as access site hematoma, pseudoaneurysm or thrombosis appear.