eMedicine Specialties > General Surgery > Abdomen

Abdominal Angina: Differential Diagnoses & Workup

Author: Carol EH Scott-Conner, MD, PhD, Professor, Department of Surgery, University of Iowa College of Medicine
Coauthor(s): Beth Ballinger, MD, Assistant Professor, Department of Surgery, Section of Vascular Surgery, University of Iowa College of Medicine
Contributor Information and Disclosures

Updated: Sep 6, 2007

Differential Diagnoses

Other Problems to Be Considered

Many patients initially are assumed to have cancer. The constellation of weight loss, abdominal pain, and an age of older than 60 years leads to a workup with GI contrast studies, CT scans, and other diagnostic tests related to malignancy, none of which are diagnostic for chronic mesenteric vascular disease.

Workup

Laboratory Studies

  • No laboratory tests are diagnostic.
  • Patients with ischemic pancreatitis may have elevated amylase or lipase levels.

Imaging Studies

  • Biplane aortography still is the criterion standard test. Because the vessels emerge from the anterior wall of the aorta, the ostia are visualized only on a lateral view (see Media file 3). 
  • A meandering mesenteric artery is another clue (see Media file 4). In addition to demonstrating the level of stenosis or occlusion of the mesenteric vessels, angiography findings also help plan the operative approach by delineating the anatomy of the supraceliac and infrarenal abdominal aorta.
  • Hydrating the patient well before angiography is extremely important, not only to avoid renal toxicity but also because visceral infarction may be precipitated by the injection of contrast.
  • Duplex ultrasound examination is emerging as a useful screening modality. It currently is most useful in patients in whom the diagnosis is suspected. If the duplex examination is positive, angiography is performed.
  • Indices that are studied include the following:
    • Peak systolic flow is increased if a stenosis is present.
    • When an increase is expected, a change in flow velocities occurs in response to feeding, unless a flow-limiting stenosis is present.
    • Perform a spectral analysis of Doppler frequencies.
  • Magnetic resonance angiography 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 is emerging as an excellent diagnostic modality due to its ability to delineate the anatomy. It also is a useful experimental tool for studying metabolic parameters.

Other Tests

  • Because most of these patients have generalized vascular disease, performing a cardiovascular evaluation prior to surgery is prudent.

More on Abdominal Angina

Overview: Abdominal Angina
Differential Diagnoses & Workup: Abdominal Angina
Treatment & Medication: Abdominal Angina
Follow-up: Abdominal Angina
Multimedia: Abdominal Angina
References
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References

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Further Reading

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Keywords

intestinal angina, chronic mesenteric ischemia, abdominal angina, postprandial abdominal angina, occlusive mesenteric vascular disease, postprandial pain, symptomatic occlusive mesenteric ischemia, central abdominal pain

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Contributor Information and Disclosures

Author

Carol EH Scott-Conner, MD, PhD, Professor, Department of Surgery, University of Iowa College of Medicine
Carol EH Scott-Conner, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Gastroenterology, American College of Surgeons, American Medical Association, American Society for Gastrointestinal Endoscopy, Association for Academic Surgery, Association for Surgical Education, Association of VA Surgeons, Iowa Medical Society, Sigma Xi, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Critical Care Medicine, Society of Surgical Oncology, Society of University Surgeons, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

Coauthor(s)

Beth Ballinger, MD, Assistant Professor, Department of Surgery, Section of Vascular Surgery, University of Iowa College of Medicine
Beth Ballinger, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Medical Association, Iowa Medical Society, and Minnesota Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Marc D Basson, MD, PhD, Chief of Surgery, John D Dingell VA Medical Center; Professor, Department of Surgery, Wayne State University School of Medicine
Marc D Basson, MD, PhD is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AMGEN Consulting fee Consulting

 
 
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