Week 3

Question 1

Where do peripheral emboli usu lodge?

Answer 1

at places where vessels narrow, like at a branch point
common in the legs & feet
brain–>stroke in 10% of cases

Question 2

What’s the deal with multiple emboli?

Answer 2

these are several traveling blood clots that break off from one blood clot
Usu this is with thrombi that form in the chambers of the heart
this happens like 25% of the time

Question 3

Why did our particular patient not have collateral pathways with which to maintain his blood flow?

Answer 3

b/c the onset was sudden & acute…no time to develop the collateral pathways.

Question 4

Let’s talk collateral pathways:

SMA to celiac artery

Answer 4

SMA
Gastroduodenal artery
Superior Pancreaticoduodenal artery (anterior & posterior)
Inferior Pancreaticoduodenal artery (anterior & posterior)
Celiac artery

Question 5

Let’s talk collateral pathways:
SMA–>IMA
Way #1

Answer 5

SMA
Middle Colic Artery
Marginal Artery
Left Colic Artery
IMA

Question 6

Let’s talk collateral pathways:
SMA–>IMA
Way #2: w/ the Arch of Riolan

Answer 6

SMA
Middle Colic Artery
Arch of Riolan
Left Colic Artery
IMA

Question 7

Why might our patient have diarrhea?

Answer 7

small bowel syndrome--lack of absorption
loss of ileocecal valve
hyper secretion of gastric acid
small bowel bacterial overload
decrease in bile acid conc'n
too many fats in the diet

Question 8

What might our patient do to cure their diarrhea?

Answer 8

smaller meals w/ lower caloric content w/ healthier foods & less fat
**with better carbs–>can be converted into fatty acids & the colon will passively absorb this.
Loperamide, Diphenoxylate/Atropine, Codeine can reduce GI motility
H2 blocker & PPI can reduce acid secretions

Question 9

Why might our patient have problems with bile acid absorption?

Answer 9

b/c he doesn’t have his ileum! This is where the fats/bile acids are absorbed.
This gives diarrhea & greasy stools, which he is experiencing.
His diet must be adjusted to minimize this effect.

Question 10

Why does our patient have megaloblastic anemia?

Answer 10

b/c he isn’t absorbing enough Vitamin B12.

This absorption takes place in the SI & that has been largely resected.