2 Mesenteric Vasculature

Question 1

Arteries that supply bowel with blood

Answer 1

Splanchnic Arteries

Question 2

What are the 3 splanchnic arteries?

Answer 2

CA, SMA and IMA

Question 3

Where do the splanchnic arteries originate from?

Answer 3

The anterior wall of the Aorta

Question 4

What does the CA (celiac artery) divide into?

Answer 4

Left Gastric
Splenic
Common Hepatic

Question 5

What do the branches of the CA supply? (5)

Answer 5

Stomach
Liver
Pancreas
Duodenum
Spleen

Question 6

CA Doppler waveform is _______ resistance

Answer 6

Low

Question 7

Celiac Artery PSV Vary from ___ to __ cm/s

Answer 7

50-160 cm/s

Question 8

Celiac Artery EDV___ cm/s?

Answer 8

< 55 cm/s

Question 9

How man cm does the SMA originate below the CA

Answer 9

1-2 cm

Question 10

Can the SMA and CA share a common trunk?

Answer 10

YES

Question 11

What does the SMA supply (4)

Answer 11

Small intestine
Cecum
Ascending colon
part of transverse colon

Question 12

Flow varys in the SMA with ?

Answer 12

metabolic gut activity

Question 13

SMA with fasting should have ____ resistance waveform with occasional ______

Answer 13

High; reversal

Question 14

THE SMA PSV varys from __ to ___ cm/s

Answer 14

110-177 cm/s

Question 15

The IMA originates from the distal aorta _ to _ cm superior to bifurcation heading to the ____.

Answer 15

3-4; left

Question 16

IMA supplies (5)

Answer 16

1. the left half of the transverse colon
2. descending colon
3. iliac
4. sigmoid colon
   5 rectum

Question 17

IMA Hard to see, but if easy may suggest ?

Answer 17

SMA occlusion

Question 18

What is the major collateral pathway that links the CA and SMA

Answer 18

Pancreaticoduodenal Arcade

via branches that surround the duodenum and the pancreas

Question 19

What are the major collateral pathways that links the IMA and SMA (2)

Answer 19

Arc of Riolan and Marginal artery of Drummond

Question 20

What is a common branch for collateralization of the Arc of Riolan and Marginal artery of Drummond

Answer 20

The Left colic-middle Artery

Question 21

Due to potential for collaterization, splanchnic arterial occlusion is often?

Answer 21

Asymptomatic

Question 22

Stenosis/Occlusion can cause acute or chronic?

Answer 22

bowel ischemia

Question 23

Stenosis/Occlusion is often prevented by?

Answer 23

collateralization

Question 24

Before assessing any mesenteric vessels which vessel should be scanned

Answer 24

Aorta

Question 25

Why should the aorta be scanned before the mesenteric vessels?

Answer 25

to document any narrowing or aneurysmal disease

Question 26

What is the gold standard for diagnosing stenosis?

Answer 26

Arteriography

Question 27

Stenosis greater than what diameter reduction are clinically significant

Answer 27

>70%

Question 28

CA PSV of what is significant?

Answer 28

>/= 200 cm/s

Question 29

SMA PSV of what is significant?

Answer 29

>/= 275

Question 30

What is the PSV for the IMA?

Answer 30

There is none

Question 31

What PSV ratio of artery/aorta indicates a significant stenosis > 70%

Answer 31

> 3.5

Question 32

When can occlusion of the CA be considered?

Answer 32

with reversal of flow in the GDA or CHA | gastroduodenal and common hepatic

Question 33

What lies superior to the celiac artery and can potentially cause compression with respiration?

Answer 33

Median arcuate ligament of the diaphragm

Question 34

What can also cause occlusion of CA

Answer 34

Atherosclerosis

Question 35

The Median arcuate ligament of the diaphragm on inspiration is there obstruction?

Answer 35

No

Question 36

The Median arcuate ligament of the diaphragm on experation is there obstruction?

Answer 36

Yes, stenotic appearance returns

Question 37

What type of patients does the The Median arcuate ligament of the diaphragm compression is seen

Answer 37

younger patients

Question 38

What is Acute Mesenteric Ischemia

Answer 38

Sudden onset of abdominal symptoms due to embolic process

Question 39

Is Acute Mesenteric Ischemia can be a ________ condition

Answer 39

life threatening

Question 40

What is the preferred method of diagnosis for Acute Mesenteric Ischemia?

Answer 40

CT angio

Question 41

What is Chronic Mesenteric Ischemia

Answer 41

Characterized by post-prandial pain (after eating)

Question 42

What does the patient need to do with Chronic Mesenteric Ischemia

Answer 42

Change their diet

Question 43

What is the best method for diagnosing Chronic Mesenteric Ischemia?

Answer 43

Angiography

Question 44

For Chronic Mesenteric Ischemia to develop is is neccessary for at least ______ to the bowel to be involved with __________

Answer 44

At least 2 major arteries; atherosclerosis

Question 45

CA pattern of blood flow is affected post prandially? YES OR NO

Answer 45

NO

Question 46

Because CA is not affected post prandially which vessels are scanned?

Answer 46

Mesenteric Arteries

Question 47

Patients are scanned both ____ and ___ parandially

Answer 47

Pre and Post

Question 48

Fasting state waveform of Mesenteric arteries are?

Answer 48

High resistance

Question 49

The study after the patient has been given a high caloric liquid meal is then repeated after _____ -____min or sooner is symptomatic. Then compared to fasting state.

Answer 49

20-30min

Question 50

NORMAL post prandial PSV and EDV in mesenteric arteries ?

Answer 50

Increase with EDV almost doubling

Question 51

ABNORMAL Waveform in fasting state of mesenteric arteries? ______ resistance _____ velocities

Answer 51

Low resistance with high velocities

Question 52

Low resistance with high velocities in fasting state is indicative of?

Answer 52

Mesenteric Ischemia | no need to test post food- velocities will remain high

Question 53

What type of test is used to assess bowl?

Answer 53

exercise stress test

Question 54

Why is bowel ischemia difficult to assess with duplex sonography?

Answer 54

It is not always due to disease in the main celiac and mesenteric arteries (hypotension, small vessel disease, emboli or venous obstruction)