Clinic-Vascular Flashcards
____ and ____ often spared ischemic injury due to good vascular supply
esophagus and stomach
this region of the colon is less well supplied bc it is at the anastomosis of the SMA and IMA
left & sigmoid colon
this region has dual blood supply, and is thus usually spared
rectum
two major categories for mesenteric ischemia
occlusive and non-occlusive (decreased blood flow = hypovolemia, hypoTN)
major cause of non-occlusive mesenteric ischemia
dehydration
mechanism of gut ischemic injury
- hypoxia, then 2. reperfusion induced superoxide radicals
the first sign of intestinal ischemia is?
abdominal pain
intestinal ischemia causes blood in the stool when?
necrosis of the surface epithelium leads to sloughing and hemorrhage
ultimately, intestinal ischemia can progress to?
infarction/”acute abdomen” with signs of peritonitis
the most common and often missed cause of intestinal ischemia is?
colonic ischemia
presentation of ischemic colitis
crampy LLQ abdominal pain, hematochezia/bloody diarrhea, pain out of proportion
risk factors for ischemic colitis
old age, cardiac, hypotensive state (dialysis, sepsis, etc), hypercoagulability
colonic ischemia most frequently occurs in the?
watershed area
dx of ischemic colitis
barium enema or colonoscopy shows “thumbprinting”, mucosal edema and erythema, hemorrhagic nodules, ulceration
tx for ischemic colitis is usually _____, but may require ____ if fulminant or perforated
supportive care (saline); surgery & ABX
acute mesenteric ischemia presents similarly to _____ and should be dx by _______
ischemic colitis (but not LLQ, often periumbilical); direct angiography (because you can tx right there)
tx of acute mesenteric ischemia
antibiotics, infuse vasodilator tx into vasculature during dx
what causes NOMI?
splanchnic vasoconstriction secondary to CV event that persists despite correction of underlying cause
chronic mesenteric ischemia is like intestinal ____, which occurs after ____ (rather than exercise)
angina; eating
sx of chronic mesenteric ischemia
abdominal peri-umbilical pain after eating, fear of eating, weight loss, nausea, diarrhea, bloating
only true tx for chronic mesenteric ischemia
revascularization
