Path Ischemic and Vascular GI disorders Flashcards Preview

GI & Liver Fall 2013 CBD > Path Ischemic and Vascular GI disorders > Flashcards

Flashcards in Path Ischemic and Vascular GI disorders Deck (27):
1

SMA branches

Right & left colic
jejunal branches
ileal branches
ileocolic loop

2

how does vascular resistance increase in intramural vasculature?

precapillary sphincters

3

3 hormones that cause vasoconstrictions in GI & their sources

catecholamines, adrenal medulla
angiotensin II, Renal JGA
vasopressin Post. pituitary

4

3 hormones that cause vasorelaxation in GI & their sources

gastrin, G cells
CCK, I cells
Secretin, S cells

5

main intra-celular system responsible for vasodilation

NO

6

main mechanism for vasoconstriction

IP3 (phosphoinositol-inosotol triphosphate)

7

ileus-sepsis

infarction

8

edema of lamina propria

pain w/o ileus

9

necrosis of villi - presentation

bleeding

10

3 categories of vascular disorders

mucosal, mural, transmural

11

ischemic colitis
(presentation, dx, tx, outcome, comments)

Presentation: hematochezia, diarrhea, abdom pain (mild 2/10), abd tenderness

Dx: abdominal CT, colonoscopy

Tx: conservative

Outcome: benign

Comments: Look for splenic flexure in watershed region

12

ileus: early or late sign?

late

13

Acute mesenteric ischemia
(presentation, dx, tx, outcome, comments)

Presentation: early abdominal pain w/o ileus. peritoneal pain only in advanced disease. +/- hematochezia

Dx: abdominal CT, XR, MRI. Angiography (high Sn/Sp) Look for "Thumb indention" in XR

Tx: ICU mgmt, vasodilators, surg

Outcome: badness

Comments: medical/surgical emergency -> necrosis.

14

Bowel infarct
(presentation, dx, tx, outcome, comments)

Presentation: sequelae of ischemia

Dx: "dusky bowel" in surg.

Tx: resect

Outcome: bad. resect.

Comments: "dusky bowel" look for curtain of hemorrhage indicating edge of necrosis/indicating depth.

15

Chronic ischemia
(presentation, dx, tx, outcome, comments)

Presentation: abdominal pain after eating

Dx: CT, MRI, US, angiography

Tx: angioplasty/stent/surg

Outcome:

Comments: at least 2/3 splanchnic arteries usually have significant occlusive disease.

16

venous mesenteric ischemia
(presentation, dx, tx, outcome, comments)

Presentation: in several days

Dx: CT, MRI, angiography

Tx: stent/surg/anticoag meds

Outcome:

Comments: associated w/hypercoagulability status

17

GI bleeding
(presentation types)

melena - above ligament of Treitz
hematochezia - below ligament of Treitz

18

Ischemic colitis vs acute mesenteric ischemia

Ischemic Colitis: <60 yo, acute cases rare, mild pain, tenderness, bleeding, colonoscopy.

Acute mesenteric ischemia: any age, acute cause, severe pain, tenderness not prominent early, bleeding uncommon, angiography

19

Acute upper GI bleeding
(presentation, dx, tx, outcome, comments)

Presentation: men/elderly,

Dx: scope

Tx: surg/scope to close

Outcome: 80% self-limiting. mortality dependent on cause. recurrence = 30% mortality risk.

Comments: most frequent GI bleed.

20

obscure overt bleeding
obscure occult bleeding

you see blood, but not source
you see no blood or source

21

low risk of rebleeding in ulcer on scope?
highest risk for rebleeding?

white base, away from large vessels lowest risk.

active bleeding highest risk. proximity to duodenal bulb bad b/c big vessels.

22

Esophageal Varices
(presentation, dx, tx, outcome, comments)

Presentation:

Dx:

Tx: banding

Outcome: mortality 30-50%. pressure, size, color are predictive.

Comments:

23

Mallory-Weiss tear
(presentation, dx, tx, outcome, comments)

Presentation: longitudinal tear at hiatal area

Dx: scope

Tx: hemodynamic stabilization and endoscopic treatment. Angiography or surgery are rarely required.

Outcome: resolves w/conservative mgmt. Bleeding stops spontaneously in 80-90%. 5% rebleed.

Comments: from retching.

24

acute lower GI bleed

outcome
acute causes
chronic causes

Outcome: mortality 3.6%


Chronic causes: hemorrhoids & neoplasia
Acute causes: Diverticulosis and angiodysplasia

25

Angiodysplasia
(presentation, comments)

Presentation: older, chronic renal failure, Ssler-Weber-Rendu, prior radiation therapy, watermelon stomach (GAVE) slow intermittent blood loss.

Comments:
primarily at cecum (37%)) & right colon (17%), sigmoid (18%)

26

appearance of esophageal ulcers:
GERD
pill-induced
CMV
herpes

GERD watermelon? red
pill-induced - spot anywhere
CMV - anywhere, large, same color as mucosa, ischemic
herpes - at GE junction

27

Define:
Osler-Weber-Rendu
Watermelon Stomach (GAVE)

autosomal dominant skin & mucosal disorder
gastric angiovascular ectasia/watermelon stomach