GI Vascular Diseases

Question 1

What is the primary learning objective regarding gastrointestinal anatomy and physiology?

Answer 1

Apply previous knowledge to understand vascular compromise within the gastrointestinal system.

Question 2

What are the three types of mesenteric ischemia that need to be differentiated?

Answer 2

Acute mesenteric ischemia, chronic mesenteric ischemia, colonic ischemia.

Question 3

What is the primary artery supplying the foregut?

Answer 3

Celiac artery.

Question 4

What is the primary artery supplying the midgut?

Answer 4

Superior mesenteric artery (SMA).

Question 5

What is the primary artery supplying the hindgut?

Answer 5

Inferior mesenteric artery (IMA).

Question 6

What percentage of cardiac output does the splanchnic circulation receive under basal conditions?

Answer 6

25%.

Question 7

What percentage of splanchnic flow goes to the mucosa?

Answer 7

70%.

Question 8

What causes ischemic injury in the gastrointestinal tract?

Answer 8

Hypoxemia and reperfusion injury.

Question 9

What is the mortality rate associated with acute mesenteric ischemia?

Answer 9

> 50%.

Question 10

What is the most common cause of acute mesenteric ischemia?

Answer 10

SMA embolism (50%).

Question 11

What are the complications of acute mesenteric ischemia?

Answer 11

Infarction, metabolic acidosis, peritonitis, cardiovascular collapse.

Question 12

What is the classic clinical presentation of mesenteric artery embolism?

Answer 12

Severe, acute abdominal pain out of proportion to physical exam findings.

Question 13

What imaging technique is considered the gold standard for diagnosing mesenteric artery conditions?

Answer 13

Mesenteric angiography.

Question 14

What is the primary treatment for mesenteric artery embolism?

Answer 14

Rapid restoration of blood flow.

Question 15

What condition is characterized by decreased venous blood flow leading to ischemia?

Answer 15

Mesenteric venous thrombosis.

Question 16

What is the gold standard for diagnosing mesenteric venous thrombosis?

Answer 16

CT with IV contrast.

Question 17

What is a common clinical presentation of chronic mesenteric ischemia?

Answer 17

Postprandial abdominal pain.

Question 18

What is the primary cause of chronic mesenteric ischemia?

Answer 18

Atherosclerotic narrowing of 2 out of 3 major vessels.

Question 19

What is the most common cause of colonic ischemia?

Answer 19

Nonocclusive ischemia.

Question 20

What is the typical clinical presentation of colonic ischemia?

Answer 20

Abrupt onset LLQ pain followed by hematochezia.

Question 21

What are angiodysplasias?

Answer 21

Aberrant blood vessels causing chronic, intermittent, painless bleeding.

Question 22

What is the gold standard for diagnosing angiodysplasias?

Answer 22

Angiography.

Question 23

What is gastric antral vascular ectasia also known as?

Answer 23

Watermelon stomach.

Question 24

What is the clinical presentation of a Dieulafoy lesion?

Answer 24

Massive acute arterial bleed.

Question 25

Fill in the blank: The treatment for mesenteric venous thrombosis with infarction is _______.

Answer 25

Emergent laparotomy to restore flow and resect necrotic bowel.

Question 26

True or False: Chronic mesenteric ischemia often presents with acute symptoms.

Answer 26

False.

Question 27

Where is a Dieulafoy lesion usually located?

Answer 27

Upper stomach/lesser curvature ## Footnote Can occur anywhere along GIT

Question 28

What is the cause of Dieulafoy lesions?

Answer 28

Unknown, possibly congenital

Question 29

What is a common clinical presentation of a Dieulafoy lesion?

Answer 29

Massive acute arterial bleed, brisk upper GI bleed leading to hematochezia

Question 30

Who is most likely to be affected by Dieulafoy lesions?

Answer 30

Usually men with cardiovascular comorbidities

Question 31

How is a Dieulafoy lesion diagnosed?

Answer 31

Visualize vessel with upper endoscopy, possibly using a Doppler probe

Question 32

What treatment options are available for Dieulafoy lesions?

Answer 32

Epinephrine injections, cautery, tattoo, hemoclip, surgery (wedge resection) if refractory

Question 33

What are some other vascular lesions mentioned?

Answer 33

* Vascular tumors * Hemangiomas * Kaposi sarcoma * Angiosarcoma * Radiation-induced vascular ectasias

Question 34

What is the most likely diagnosis for a 68-year-old male with sudden severe periumbilical abdominal pain, nausea, and a history of cardiovascular issues?

Answer 34

Acute mesenteric ischemia

Question 35

What other clinical findings or lab values are likely to be seen with the patient presenting with acute mesenteric ischemia?

Answer 35

leukocytosis; red currant-jelly stools

Question 36

What additional medication should a patient with a history of hypertension, diabetes, and atrial fibrillation be taking?

Answer 36

Pt. should also be taking anticoagulants like Warfarin

Question 37

What does the CHA2DS2-VASc score assess?

Answer 37

Stroke risk in patients with atrial fibrillation

Question 38

What factors contribute to the CHA2DS2-VASc score? List them.

Answer 38

* CHF: 1 * HTN: 1 * Age ≥ 75: 2 * DM: 1 * Prior stroke/TIA/thromboembolism: 2 * Vascular disease: 1 * Age 65-75: 1 * Sex category: 1

Question 39

What is the most likely diagnosis for a 79-year-old male with progressively worsening abdominal pain after eating and weight loss?

Answer 39

Chronic mesenteric ischemia

Question 40

What is the pathophysiology of chronic mesenteric ischemia?

Answer 40

Narrowed, atherosclerotic intestinal vessels

Question 41

What does a positive stool guaiac indicate?

Answer 41

Possible gastrointestinal bleeding

Question 42

What lab results are indicative of iron deficiency anemia in an 83-year-old female?

Answer 42

Hgb 9.5 g/dL and MCV 75 fL

Question 43

What is the next appropriate step after diagnosing iron deficiency anemia?

Answer 43

Stool Guaiac

Question 44

Is treatment necessary for iron deficiency anemia?

Answer 44

Yes

Question 45

What other pathology should be looked for in a patient with iron deficiency anemia?

Answer 45

atherosclerosis & CKD

Question 46

What is a key takeaway regarding intestinal ischemia?

Answer 46

Various presentations are important to recognize to reduce morbidity and mortality

Question 47

What is a common cause of gastrointestinal bleeding in aging populations?

Answer 47

Vascular lesions

Question 48

What are risk factors for angiodysplasia

Answer 48

OWR Syndrome (rare AD disease): absence of capillary beds b/t intestinal arterioles & venules; Scleroderma CKD: uremia induced platelet dysfunction Aortic Stenosis: acquired Von Will disease

Question 49

How is GAVE Histologically defined

Answer 49

a form of arteriosclerosis: fibro-hyalinosis: thickening of arterial wall by deposits of pink hyaline

Question 50

What are the clinical characteristics of a D. Lesion?

Answer 50

commonly seen in older men w/ CVD comorbidities usually located in the upper stomach regions described as an eroded artery