Angina abdominalis is the pain of impaired blood flow to the intestines, which usually occurs due to arteriosclerosis of the blood vessels supplying the intestines. It usually occurs as diffuse abdominal pain immediately after eating and thus may be a warning sign of impending mesenteric infarction.
What is angina abdominalis?
Angina abdominalis is a symptom of impaired blood flow to the abdominal vessels. “Angina” in this context refers to the pain condition, and “abdomen” is the medical term for the abdomen. Similarly, there is also angina pectoris, which is far better known and refers to the chest pain associated with a heart attack. However, the pathological cause behind these two pain events is the same.
Causes
The blood supply to the intestine originates in the great aorta and then distributes through various defined branches to its destinations in the small and large intestinal wall. Blood is needed here primarily when work is pending: After a meal, the intestine is in big action, consuming oxygen for active digestion and also needing the blood as a means of transporting the many nutrients it absorbs toward the liver. If the vessels of the intestine are arteriosclerotically calcified and constricted, this is therefore particularly noticeable after eating: The blood supply has nothing more to add due to the rigid vessels and continues to supply the same amount of blood as before the meal. However, this is now no longer sufficient, the intestine does not get enough oxygen and responds with massive pain. Incidentally, exactly the same thing happens with angina pectoris and the subsequent heart attack – only here the complaints always occur when the heart needs a lot of oxygen: when running, climbing stairs, during physical work.
Symptoms, complaints and signs
The symptoms of angina abdominalis depend on the severity of the circulatory disturbances in the abdominal vessels. The condition can be divided into four stages. In stage I, there are no symptoms at all. Often, it is an incidental finding. If the vessels narrow further, stage II occurs, at which point severe abdominal pain may already occur after meals. The greater the amount of food consumed, the more severe the pain. The patient frequently takes smaller meals to relieve the discomfort. In stage III, the pain is permanent. Only its intensity varies, which also depends on the amount of food ingested. The fourth stage of angina abdominalis is characterized by an acute abdomen with a frequently lethal outcome. In the event of complete occlusion of certain intestinal arteries, the affected section of the intestine can no longer be supplied with blood and blood supply. This often leads to the death of entire loops of intestine. If not treated in time, the intestine ruptures and the intestinal contents spill into the abdominal cavity. If left untreated, this leads to a life-threatening peritonitis. After the vascular occlusion, the previously existing long-term abdominal pain initially disappears. After about 24 hours, an acute abdomen develops, which is characterized by a hardened abdominal wall with guarding, fever and palpitations. Life-threatening complications such as circulatory shock, intestinal paralysis, or sepsis may then occur.
Diagnosis and course
The symptom angina abdominalis can often occur on and off for weeks or months after eating and disappear shortly thereafter, without anything serious happening initially. However, depending on the condition of the blood vessels, progressive calcification and more or less developed collateral supply, damage to the intestinal wall can occur in the long term, which then no longer transports and absorbs the food pulp properly. Malnutrition, constipation, diarrhea and bloody stools can be the result. In the worst case, a mesenteric infarction occurs, analogous to a heart attack, when the blood supply to the intestinal wall acutely becomes so poor or stops completely that the section of intestine dependent on it dies. Here, one typically has massive pain for a few hours, which then suddenly gets better (“rotten peace”), only to return irrevocably a few hours later. Such a damaged intestine often cannot be saved even surgically and floods the body with toxic and acidic substances within a very short time, which not infrequently ends fatally.Massive abdominal pain after eating should therefore lead everyone immediately to the doctor or call the emergency doctor. Even from the “lazy peace” should not be dissuaded. Based on the typical symptoms of angina abdominalis, a doctor can make the diagnosis with sufficient certainty. Since arteriosclerosis usually does not occur in just one region of the body but affects the entire body, heart complaints, leg pain, elevated blood lipid levels, high blood pressure or diabetes are further indications that the abdominal pain is probably vascular. Atrial fibrillation may also contribute to the symptoms of calcified abdominal vessels via carried blood clots from the atrium.
Complications
If angina abdominalis is not recognized in time, inflammation of the intestinal tissues (ischemic colitis) occurs with persistent abdominal pain, especially after food intake. If these remain untreated, an intestinal infarction (mesenteric infarction) may follow. Initially, the patient experiences stabbing pains in the intestinal region for a few hours, which recur after a short time. If a doctor is not consulted at this stage, the affected parts of the intestine begin to die off irretrievably. In addition, this stage is often accompanied by peritonitis, which now causes long-lasting severe abdominal pain. The only remedy after the onset of infarction is immediate surgery. Here, the dead parts of the intestine are removed and the blood circulation system of the digestive tract is stabilized. The later this operation is performed, the lower the probability of promising results. By hesitating too long, an enormous loss of intestinal length must be expected. Digestive disorders occur with consequences such as dehydration, nutrient deficiency, diarrhea, weight loss. In the worst case, short bowel syndrome sets in. Since angina abdominalis is a clinical picture triggered by arterial dysfunction, heart attacks or strokes often occur in the same patients.
When should you see a doctor?
If there is recurrent pain or pressure in the intestinal tract, the family doctor or a gastroenterologist should be consulted. The physician can determine from the symptoms and a physical examination whether angina abdominalis is present and, if so, begin treatment immediately. Because of the acute risk of infarction, surgery is usually performed immediately after diagnosis. The visit to the doctor should not be postponed for this reason. A visit to the doctor is particularly advisable if symptoms of bowel disease recur. Clear warning signs are constipation, diarrhea and bloody stools. It is also characteristic that severe abdominal pain occurs 15 to 30 minutes after food intake. If these symptoms occur, it is important to see a doctor and clarify the cause. People with pre-existing conditions such as high blood pressure, high blood lipid levels or diabetes should talk to their doctor immediately if these symptoms occur. In the case of chronic abdominal pain, the intestinal tissue may already be inflamed and angina abdominalis must be treated surgically immediately.
Treatment and therapy
A blood test for acid metabolites can acutely confirm the suspicion of mesenteric infarction or make it unlikely. Analogous to cardiac catheterization for chest pain, there is also radiologic contrast examination for abdominal pain due to blood flow, which allows the condition of the blood vessels to be assessed. However, it does not have to be performed immediately in all cases. Therapeutically, blood thinning and anticoagulation with ASA or Marcumar are the mainstay of treatment. This reduces the likelihood of further clots forming in the already narrowed arteries and completely blocking the vessel. In acute infarction, heparin administration, pain therapy, and immediate emergency surgery also become necessary.
Outlook and prognosis
In many cases, early treatment of angina abdominalis cannot occur because the symptoms and signs are not particularly clear or characteristic. In most cases, however, affected individuals suffer from relatively severe abdominal pain, which occurs primarily after eating and thus significantly reduces the quality of life of the affected individual. It is not uncommon for diarrhea or constipation to occur, resulting in deficiency symptoms. Furthermore, the patient’s bowel movements may also be bloody.Not infrequently, angina abdominalis also leads to heart complaints and elevated blood lipid levels. Leg pain may also occur and be accompanied by diabetes. Without treatment of angina abdominalis, the patient’s life expectancy will be significantly limited and reduced. The treatment itself can take place with the help of medications, greatly alleviating the symptoms. In some cases or in acute emergencies, surgical intervention is necessary. Whether this will result in a reduction in the patient’s life expectancy cannot usually be predicted. In most cases, a healthy lifestyle with a healthy diet can also have a very positive effect on this disease.
Prevention
Prevention is also better than aftercare in this case: the risk of atherosclerosis can be minimized with a healthy lifestyle. This means: no smoking, little alcohol, Mediterranean diet, avoid stress, moderate but regular exercise. High blood pressure and [[diabetes mellitus]] as well as elevated blood lipids massively increase the risk of arteriosclerosis and should therefore also be avoided or consistently treated.
Follow-up care
Angina abdominalis may recur after healing. Patients do not build up immunity. The purpose of follow-up care is to prevent recurrent symptoms. Affected individuals bear the main responsibility for this. They must refrain from unhealthy lifestyle habits. Medical check-ups include physical examinations and a detailed discussion of symptoms. Imaging procedures such as a CT scan and MRI can provide clarity. Patients usually contact their physicians with specific signs. Various behaviors that can be subsumed under the term “healthy lifestyle” have become established as an essential means of preventing angina abdominalis. Above all, this means generally abstaining from addictive substances such as nicotine and alcohol. In addition, patients should maintain a balanced diet. Several portions of fruit and vegetables belong on the daily menu. Physical exercise provides the necessary fitness. Stress in everyday life and at work should be avoided. Successful treatment is not infrequently surgical. In the following weeks, follow-up care aims to prevent complications. Patients must take it easy, so recovery phases must be planned. Food intake should ideally start with small meals spread throughout the day. Depending on the procedure, regular bowel monitoring may be necessary thereafter.
What you can do yourself
Angina abdominalis does not fall within the scope of self-treatment. This condition can develop into a life-threatening condition and requires immediate medical, possibly emergency, care. Measures from the area of self-treatment can only be carried out concomitantly or postoperatively. In any case, the body can be supported by consistently abstaining from nicotine and alcohol. Those affected should pay attention to a balanced diet rich in fiber. Above all, the proportion of fruit and vegetables should be increased. This provides the body with important vitamins and minerals. This supports the entire healing process. Supplementary intake of micronutrients in powder or tablet form can be considered. Basically, anything that supports digestion as well as blood circulation is helpful. This also includes regular exercise in fresh air and reducing stress as well as sufficient fluid intake (preferably still mineral water or unsweetened herbal teas). Immediately after surgery, it is imperative to maintain physical rest. Initially, a gradual diet build-up – with several small meals – will also be necessary. With timely treatment, patients can live again without major restrictions. If parts of the intestine have to be removed, more attention must be paid to digestion in the future. Elderly people and diabetics in particular – who count as risk groups – should have their intestinal vessels checked regularly. This can be done by the family doctor or an internist.
