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Gastroenterology > Mesenteric Vascular Disease > Flashcards

Mesenteric Vascular Disease Flashcards

1
Q

What part of the intestines is supplied by the celiac plexus?

A

Stomach and duodenum

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2
Q

What part of the intestines is supplied by the SMA?

A

Small bowel from distal duodenum to mid-transverse colon

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3
Q

What part of the intestines is supplied by the IMA?

A

Transverse colon to the rectum

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4
Q

Which arteries provide collateral circulation between the celiac axis and SMA?

A

Superior and inferior pancreatoduodenal arteries

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5
Q

What are two arterial structures that provides collaterals between SMA and IMA?

A

Marginal artery of Drummond

Arc of Riolan

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6
Q

Which artery provides collateral flow between the aorta and celiac axis?

A

Phrenic artery

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7
Q

Which arteries provide collateral flow to the rectum?

A

Internal iliac arteries

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8
Q

What are two watershed areas in the colonic blood supply that are common locations for ischemia?

A
  1. Griffith point in splenic flexure

2. Sudeck point in rectosigmoid

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9
Q

What percentage of cardiac blood flow goes to the splanchnic circulation under basal conditions?

A

25%

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10
Q

What percentage of cardiac output goes to the splanchnic circulation post-prandially?

A

At least 35%

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11
Q

What is the classic patient to present with acute mesenteric ischemia?

A
  • Age > 50
  • Hx cardiovascular diseas
  • Sudden onset of abdominal pain that is out of proportion to physical exam
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12
Q

What is the diagnostic procedure of choice for acute mesenteric ischemia?

A

Angiography

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13
Q

What are the 4 main causes of acute mesenteric ischemia?

A
  1. SMA embolism (50%)
  2. SMA thrombosis (15-20%)
  3. Nonocclussive mesenteric ischemia (NOMA) 20-25%
  4. Mesenteric venous thrombosis (5-10%)
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14
Q

What percentage of patients with acute mesenteric artery thrombosis have chronic intestinal ischemia?

A

50%

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15
Q

What is the role of plain abdominal x-rays in acute mesenteric ischemia?

A

To rule out other acute abdominal processes such as perforation or obstruction

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16
Q

Although angiography is the gold standard for diagnosing acute mesenteric ischemia, what other imaging modality has an 80% sensitivity?

A

CT

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17
Q

What is the treatment of choice for patients with acute mesenteric ischemia without peritoneal signs?

A

Angiography

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18
Q

What is the treatment of choice for patients with acute mesenteric ischemia and peritoneal signs?

A

Emergent laparotomy

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19
Q

What are 3 signs of intestinal ischemia on CT?

A
  1. Small bowel thickening
  2. Small intestinal pneumatosis
  3. Portal venous gas
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20
Q

What are 3 main causes of mesenteric vein thrombosis?

A
  1. Hypercoagulable state
  2. Inflammatory disorders (eg pancreatitis, intra-abdominal sepsis)
  3. Cirrhosis and portal hypertension
21
Q

The 3 main causes of mesenteric vein thrombosis (hypercoagulable state, inflammatory disorders, cirrhosis/portal HTN) account for what percentage of cases?

A

80%

22
Q

What is the gold standard for diagnosis of mesenteric vein thrombosis?

A

CT with IV contrast

23
Q

What is the classic finding on CT with IV contrast of mesenteric vein thrombosis, with 90% sensitivity?

A

Dilated SMV with clot or filling defect in lumen

24
Q

What is the treatment of mesenteric vein thrombosis with peritoneal signs?

A

Surgery

25
Q

What is conservative treatment of mesenteric vein thrombosis in the absence of peritoneal signs and good mesenteric blood flow demonstrated by angiography?

A

Anticoagulation for 6 months

26
Q

Which patients typically develop no occlusive mesenteric ischemia?

A

Elderly with diffuse vascular disease

27
Q

What is the gold standard for diagnosis and management?

A

Angiography

28
Q

Which medication, delivered intra-arterially, can reverse vasoconstriction and restore mesenteric blood flow?

A

Papaverine

29
Q

What are the three main arteries that supply the intestines?

A
  1. Celiac artery
  2. Superior mesenteric artery (SMA)
  3. Inferior mesenteric artery (IMA)
30
Q

Which intestinal artery is most likely to be embolized from dislodged clot from the left atrium, left ventricle or cardiac valves?

A

Superior mesenteric artery (SMA)

31
Q

Acute thrombosis of the SMA usually occurs at the __1__ of the vessel, which is often severely narrowed due to __2__

A
  1. origin

2. atherosclerosis

32
Q

Chronic mesenteric ischemia results from reduced blood flow from luminal narrowing due to ____ of at least two of three major arteries (i.e. celiac axis, SMA, IMA)

A

atherosclerosis

33
Q

What is the classic triad for chronic mesenteric ischemia (CMI)?

A
  1. postprandial abdominal pain
  2. weight loss
  3. abdominal (epigastric) bruit
34
Q

What percentage of patients have an abdominal (epigastric) bruit in chronic mesenteric ischemia?

A

50%

35
Q

Although angiography is the diagnostic test of choice, what other (3) tests may be useful for measuring mesenteric blood flow?

A
  1. CT angiography
  2. Magnetic resonance angiography (MRA)
  3. Doppler ultrasound
36
Q

It is important to correlate angiographic findings with symptoms as patients may have complete occlusion of all three major mesenteric arteries but still remain asymptomatic. Why?

A

Collateral blood flow

37
Q

What is the most common form of mesenteric ischemia?

A

Colonic ischemia, i.e. ischemic colitis

38
Q

Colonic ischemia may be initially misdiagnosed as either __1__ or __2__

A
  1. IBD

2. Infectious colitis

39
Q

Patients who recently have had ____ surgery are at highest risk for colonic ischemia

A

cardiovascular

40
Q

What percentage of cases of colonic ischemia spontaneously resolve within 2 weeks?

A

85%

41
Q

What are the two watershed areas of the colon?

A
  1. Splenic flexure

2. Left colon

42
Q

Why are gangrenous colitis and colonic strictures rare in ischemic colitis/colonic ischemia?

A

Colonic ischemia is usually mucosal and rarely transmural

43
Q

More than 90% of patients with colonic ischemia are over the age of ____?

A

60

44
Q

What is the typical presentation of colonic ischemia?

A

Cramps left lower quadrant pain with mild to moderate real bleeding or bloody diarrhea within 24 hours

45
Q

What triad is associated with colonic ischemia in young women?

A
  1. Smoking
  2. Oral contraceptives
  3. Factor V leiden
46
Q

PCN-derived drugs given to patients with Klebsiella oxytoca may precipitate ____ ____

A

hemorrhagic colitis

47
Q

What diagnostic procedure makes a definitive diagnosis in patients with colonic ischemia/ischemic colitis?

A

Colonoscopy with biopsy

48
Q

What stool studies should be ordered to evaluate ischemic colitis to rule out infection causing hemorrhagic colitis?

A
  1. Escherichia coli O157:H7
  2. Campylobacter enteritis
  3. Klebsiella oxytoca
  4. Shigella
  5. Clostridium difficile

Gastroenterology (5 decks)

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