Abdominal Angina - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The human abdomen, also known as the belly, is the space between the chest and pelvis. It includes many vital organs such as the liver, stomach, intestines, etc. The abdomen makes up the digestive system of the human body and also has other various functions such as breathing, posture, balance of the body, movement, etc.

Various types of abdominal conditions also include abdominal angina. The word angina is a Latin word that means choke. It means the blood vessels in the abdomen get choked because of low blood supply. This condition may occur due to blockage or obstruction in the vessels. Because the mortality rate is high, abdominal angina should not be ignored or left untreated. This condition is more common in women and elderly people who are above 60 years of age.

What Is Abdominal Angina?

When pain occurs in the chest of the human body because of the reduced blood supply in the heart, it is called angina. Abdominal angina is the recurrent and long-standing pain in the abdomen because of reduced blood supply from the arteries present in the mid part of the gut. It occurs when more than two arteries are blocked. It is also known as intestinal angina, intestinal ischemia, and bowelgina.

What Are the Types of Abdominal Angina?

Based on the severity and location of angina, there are four categories:

1. Colonic Ischemia - It is the most common condition in which the blood supply in the colon is reduced.

2. Acute Mesenteric Artery Ischemia - It is a syndrome caused by an insufficient blood supply in the mesenteric vessels resulting in ischemia.

3. Chronic Mesenteric Artery Ischemia - It occurs in the arteries supplying the intestines because of blockage.

4. Mesenteric Venous Thrombosis - It occurs because of blood clots formed in the veins of the intestines.

What Are the Causes of Abdominal Angina?

Abdominal angina is caused by:

1. Insufficient Blood Flow - When the arteries fail to meet or overcome the demands of the system required while digesting food, it results in insufficient blood flow in the arteries.

2. Stenosis - It is the most common cause of abdominal angina. Stenosis is the narrowing of the celiac artery.

3. Age - Elderly age, usually above 60 years, is a risk factor for abdominal angina.

4. Aneurysm - It is the ballooning of the mesenteric artery wall.

5. Vasculitis - It is the inflammation of the blood vessels.

6. Fibromuscular Hyperplasia - It is a lesion of arteries.

7. Malignancy - Cancer in the celiac artery.

What Are the Symptoms of Abdominal Angina?

• Severe pain and/or cramping in the stomach. The pain occurs only after eating food, usually after 15 to 30 minutes.

• Weight loss.

• Pain in the stomach subsides within two to three hours.

• Diarrhea.

How to Diagnose Abdominal Angina?

1. Physical Examination: Upon examination, the doctor may hear a murmuring sound from the abdomen - bruit.

2. Medical History: The patient may give a history of smoking, pain in the arms or legs (claudication), and increased fat in the blood (hyperlipidemia). It is also important to ask the patient about atherosclerotic symptoms or the presence of the condition because it acts as a predisposing factor. Atherosclerotic condition is the thickening of arteries. Other common conditions such as diabetes and blood pressure also play an important role in causing an abdominal abscess.

3. Lab Test: There is no specific lab test that helps identify or confirm the diagnosis.

4. Imaging Test: Angiogram or mesenteric angiogram is the gold standard diagnostic tool. An X-ray is done to examine the blood vessels of the intestines. A computed tomography (CT) scan along with angiography is done by injecting a dye into the veins. The dye creates images of the blockages and other abnormalities present.

5. Pulmonary Function Tests: These may be helpful in patients with heavy smoking habits. The test examines the functional status of the lungs.

What Is the Treatment for Abdominal Angina?

The treatment approach for abdominal angina depends on various factors such as the age of the patient, related medical history, presence of underlying disease, etc. In general, the treatment includes the following:

1. Antibiotic Therapy: It is the first line of treatment. Antibiotics will help in removing bacterial infection and support the healing process.

2. Treatment of Underlying Disease: If the patient has any underlying disease such as diabetes, blood pressure, increased or high levels of fat in the body, etc., then it should be treated with suitable medications, dietary changes, and exercise.

3. Change in Eating Pattern: The patient should be instructed to eat small portions of meals to prevent the abdominal pain that occurs after having food.

4. Surgical Treatment: The surgery is done to relieve the angina-related symptoms. Different surgical methods are:

• Thrombectomy: It is the removal of blood clots or obstructing lesions from the vessels. Intravenous injections are given to the patient to give a blood thinner such as Heparin because it prevents the formation of new blood clots. The surgery will be done under local or general anesthesia. An incision is made in the affected area, such as the abdomen. The doctor will remove the blood clot from the blood vessel. The blood vessel will be closed and repaired. The incision will be closed and sealed with a dressing. Sometimes, the obstruction is bypassed if not removed.

• Angioplasty and Stenting: It is ballooning of the blocked blood vessels such that they are stretched. Then a thin wire or mesh tube is inserted into the blood vessels to prevent blocking in the future - stent. The stent remains in the blood vessels permanently and/or lifetime. This procedure helps in revascularizing the vessels.

How Long Can a Patient Live With Abdominal Angina?

The death rate or mortality of abdominal angina is between 60 to 95 %; the patient may live for five to ten years.

What Are the Complications of Abdominal Angina?

The common complications are:

• Weight Loss - The blockage or obstruction in the blood vessels of the abdomen also affects the digestive system. This may result in vomiting, eventually leading to a low intake of food, loss of appetite, and weight loss.

• Ischemic Bowel - It occurs when the blood supply of the intestine is reduced because of blockage or fat deposition.

• Blood Loss - It may occur because of the bleeding from the infected area.

• Spread of Infection - The infection in the abdomen may spread further in the body, affecting other body parts or organs.

• Bowel Infarction - It is an injury of the intestines occurring from the decreased blood supply.

• Ileus - It is a condition in which the intestinal muscles do not contract.

Conclusion

Abdominal abscess causes severe pain in the abdomen that repeatedly occurs when the patient eats food. It occurs because of reduced blood supply in the abdomen, resulting in increased abdominal pressure. There is no definitive or effective medical treatment available for this condition. It has a high death rate, and therefore, it must be treated immediately through a surgical approach along with conservative treatment. Treating the underlying cause of the disease is the best approach. Even after the completion of treatment, the patient must make dietary and lifestyle changes such as a nutritious diet, regular exercise, and complete cessation of smoking.