Ischemic and Vascular GI

Question 1

What artery supplies the small intestines?

Answer 1

Superior Mesenteric Artery

Question 2

Atrial fibrillation often leads to what?

Answer 2

Development of thrombosis in the atrium which can travel to the SMA and lead to ischemic bowel

Question 3

Connection between the Celiac artery and the SMA?

Answer 3

Pancrealicoduodenal arcade

Question 4

Connection between the SMA and IMA

Answer 4

Arc of Riolan

Question 5

Vasodilators in the GI?

Answer 5

Gastrin, CCK, Secretin

All released during feeding

Question 6

Vasoconstrictors in teh GI

Answer 6

Catecholamines, Ang II, Vasopressin

Question 7

How is the GI system affected by hypovolemia

Answer 7

Massive hemorrhage–> reduced blood volume–> decreased venous return to the heart –> Hypotension and low Cardiac Output—> Increased peripheral resistance –> Redistribution of blood flow to vital organs (heart, brain, lungs, kidneys) –> decreased splanchnic blood flow

Question 8

Which part of the bowel will be injured first in response to low blood flow?

Answer 8

Tops of Villi, the necrosis proceeds downward from there.

Patients will have different symptoms depending on what level the infarction has reached

Question 9

Know the different levels of infarction

Answer 9

Mucosal, Mural , Transmural

Question 10

Ischemic colitis presentation

Answer 10

Bleeding but pain level may be low

Diarrhea may be present

Question 11

In Ischemic Colitis, what area of the small bowel is most sensitive to ulcer development? KNOW

Answer 11

Splenic Flexure or between the sigmoid colon and rectum…Apparently areas where we have connections between the two big vessels

Question 12

Acute Mesenteric Ischemia is what

Answer 12

First off, its a medical emergency because delaying treatment can lead to bowel necrosis

Question 13

Clinical presentation of Acute Mesenteric Ischemia is what

Answer 13

Early abdominal pain without Ileus (obstruction)

Question 14

How do you diagnose Ischemic colitis?

Answer 14

CT and colonscopy

Question 15

How do you diagnose acute mesenteric ischemia

Answer 15

CT. NO ENDOSCOPY

Angiography is gold standard….injecting contrast in arteries and look on CT

Question 16

Portal vein gas?

Answer 16

Usually associated with acute mesenteric ischemia…not a good sign because it usually represents complete necrosis of teh bowel wall

Question 17

Tx of acute mesenteric ischemia

Answer 17

vasodilators via angiography. Surgery is the only possible cure but its very risky and outcome is poor

Question 18

Dusky Bowel

Answer 18

Bowel Infarct

Question 19

Know distinguisihng features slide

Answer 19

ok

Question 20

Chronic ischemia criteria/cause?

Answer 20

At least two of the three splanchnic arteries usually have serious occlusion

Question 21

Presentation of Chronic ischemia

Answer 21

Abdominal Pain after eating, they lose a lot of weight because they don’t eat much

Question 22

Venous mesenteric Ischemia cause

Answer 22

Hyper-coaguable state (often due to an autoimmune disorder which means that women are affected more than men)

Question 23

Upper GI bleed classified how

Answer 23

Bleeding that comes from above the angle of Trait

Question 24

Lower GI bleed classified how

Answer 24

Bleeding that comes from below the angle of trait

Question 25

What the hell is the angle of trait

Answer 25

It is a fibrous ligament that attaches the junctin between the duodenum and jejunum to the diaphragm

Question 26

Obscure overt bleeding

Answer 26

You can see the blood but you don;t know where its from

Question 27

Obscure occult bleeding

Answer 27

You cannot see the blood nor do you know where its coming from

Question 28

What is melena?

Answer 28

Black, tarry, loose or sticky stool caused by degraded blood in the intestine and generally indicates an upper GI source. Smells bad

Question 29

Hematochezia

Answer 29

Bright red blood from the rectum, lower Gi usually. If it comes from upper GI then you have a massive hemorrhage

Question 30

Upper Gi bleeding more common in who

Answer 30

men and the elderly

Question 31

80% of upper GI bleeds are self-limited

Answer 31

ok

Question 32

Causes of upper GI bleeds

Answer 32

``` ulcers gastritis tumors vascular malformation esophagitis ```

Question 33

During endoscopy, what finding signifies the highest risk of re-bleeding?

Answer 33

Active bleeding during the procedure

Question 34

During endoscopy, what finding signifies the second highest risk of re-bleed?

Answer 34

Visualization of a Stigmata ( a visible vessel that looks like it is about to explode)

Question 35

Low risk of re-bleed

Answer 35

Completely white

Question 36

What locations in the GI can lead to high risk of re-bleed?

Answer 36

Posterior wall of the duodenal bulb or lesser curve of stomach

Question 37

Esophageal varices mortality

Answer 37

30-50%

Question 38

Most common cause of acute lower GI bleed?

Answer 38

Diverticulosis and angiodysplasia

Question 39

Most common cause of chronic bleed

Answer 39

Hemorrhoids and neoplasia

Question 40

Angiodysplasia is what

Answer 40

AVM (arteriovenous malformation)

Question 41

Risk factors for angiodysplasia development?

Answer 41

Chronic lver failure, old age, prior radiation therapy

Question 42

Angiodysplasia blood loss most commonly where

Answer 42

cecum and right side colon

Question 43

slow intermittent blood loss= Angiodysplasia

Answer 43

ok