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VASCULAR 4 > 2 Mesenteric Vasculature > Flashcards

2 Mesenteric Vasculature Flashcards

1
Q

Arteries that supply bowel with blood

A

Splanchnic Arteries

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2
Q

What are the 3 splanchnic arteries?

A

CA, SMA and IMA

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3
Q

Where do the splanchnic arteries originate from?

A

The anterior wall of the Aorta

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4
Q

What does the CA (celiac artery) divide into?

A

Left Gastric
Splenic
Common Hepatic

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5
Q

What do the branches of the CA supply? (5)

A 
Stomach
Liver
Pancreas
Duodenum
Spleen
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6
Q

CA Doppler waveform is _______ resistance

A

Low

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7
Q

Celiac Artery PSV Vary from ___ to __ cm/s

A

50-160 cm/s

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8
Q

Celiac Artery EDV___ cm/s?

A

< 55 cm/s

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9
Q

How man cm does the SMA originate below the CA

A

1-2 cm

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10
Q

Can the SMA and CA share a common trunk?

A

YES

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11
Q

What does the SMA supply (4)

A

Small intestine
Cecum
Ascending colon
part of transverse colon

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12
Q

Flow varys in the SMA with ?

A

metabolic gut activity

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13
Q

SMA with fasting should have ____ resistance waveform with occasional ______

A

High; reversal

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14
Q

THE SMA PSV varys from __ to ___ cm/s

A

110-177 cm/s

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15
Q

The IMA originates from the distal aorta _ to _ cm superior to bifurcation heading to the ____.

A

3-4; left

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16
Q

IMA supplies (5)

A
  1. the left half of the transverse colon
  2. descending colon
  3. iliac
  4. sigmoid colon
    5 rectum
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17
Q

IMA Hard to see, but if easy may suggest ?

A

SMA occlusion

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18
Q

What is the major collateral pathway that links the CA and SMA

A

Pancreaticoduodenal Arcade

via branches that surround the duodenum and the pancreas

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19
Q

What are the major collateral pathways that links the IMA and SMA (2)

A

Arc of Riolan and Marginal artery of Drummond

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20
Q

What is a common branch for collateralization of the Arc of Riolan and Marginal artery of Drummond

A

The Left colic-middle Artery

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21
Q

Due to potential for collaterization, splanchnic arterial occlusion is often?

A

Asymptomatic

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22
Q

Stenosis/Occlusion can cause acute or chronic?

A

bowel ischemia

23
Q

Stenosis/Occlusion is often prevented by?

A

collateralization

24
Q

Before assessing any mesenteric vessels which vessel should be scanned

A

Aorta

25
Q

Why should the aorta be scanned before the mesenteric vessels?

A

to document any narrowing or aneurysmal disease

26
Q

What is the gold standard for diagnosing stenosis?

A

Arteriography

27
Q

Stenosis greater than what diameter reduction are clinically significant

A

> 70%

28
Q

CA PSV of what is significant?

A

> /= 200 cm/s

29
Q

SMA PSV of what is significant?

A

> /= 275

30
Q

What is the PSV for the IMA?

A

There is none

31
Q

What PSV ratio of artery/aorta indicates a significant stenosis > 70%

A

> 3.5

32
Q

When can occlusion of the CA be considered?

A

with reversal of flow in the GDA or CHA

gastroduodenal and common hepatic

33
Q

What lies superior to the celiac artery and can potentially cause compression with respiration?

A

Median arcuate ligament of the diaphragm

34
Q

What can also cause occlusion of CA

A

Atherosclerosis

35
Q

The Median arcuate ligament of the diaphragm on inspiration is there obstruction?

A

No

36
Q

The Median arcuate ligament of the diaphragm on experation is there obstruction?

A

Yes, stenotic appearance returns

37
Q

What type of patients does the The Median arcuate ligament of the diaphragm compression is seen

A

younger patients

38
Q

What is Acute Mesenteric Ischemia

A

Sudden onset of abdominal symptoms due to embolic process

39
Q

Is Acute Mesenteric Ischemia can be a ________ condition

A

life threatening

40
Q

What is the preferred method of diagnosis for Acute Mesenteric Ischemia?

A

CT angio

41
Q

What is Chronic Mesenteric Ischemia

A

Characterized by post-prandial pain (after eating)

42
Q

What does the patient need to do with Chronic Mesenteric Ischemia

A

Change their diet

43
Q

What is the best method for diagnosing Chronic Mesenteric Ischemia?

A

Angiography

44
Q

For Chronic Mesenteric Ischemia to develop is is neccessary for at least ______ to the bowel to be involved with __________

A

At least 2 major arteries; atherosclerosis

45
Q

CA pattern of blood flow is affected post prandially? YES OR NO

A

NO

46
Q

Because CA is not affected post prandially which vessels are scanned?

A

Mesenteric Arteries

47
Q

Patients are scanned both ____ and ___ parandially

A

Pre and Post

48
Q

Fasting state waveform of Mesenteric arteries are?

A

High resistance

49
Q

The study after the patient has been given a high caloric liquid meal is then repeated after _____ -____min or sooner is symptomatic. Then compared to fasting state.

A

20-30min

50
Q

NORMAL post prandial PSV and EDV in mesenteric arteries ?

A

Increase with EDV almost doubling

51
Q

ABNORMAL Waveform in fasting state of mesenteric arteries? ______ resistance _____ velocities

A

Low resistance with high velocities

52
Q

Low resistance with high velocities in fasting state is indicative of?

A

Mesenteric Ischemia

no need to test post food- velocities will remain high

53
Q

What type of test is used to assess bowl?

A

exercise stress test

54
Q

Why is bowel ischemia difficult to assess with duplex sonography?

A

It is not always due to disease in the main celiac and mesenteric arteries

(hypotension, small vessel disease, emboli or venous obstruction)

VASCULAR 4 (8 decks)

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