Clinic-Vascular

Question 1

____ and ____ often spared ischemic injury due to good vascular supply

Answer 1

esophagus and stomach

Question 2

this region of the colon is less well supplied bc it is at the anastomosis of the SMA and IMA

Answer 2

left & sigmoid colon

Question 3

this region has dual blood supply, and is thus usually spared

Answer 3

rectum

Question 4

two major categories for mesenteric ischemia

Answer 4

occlusive and non-occlusive (decreased blood flow = hypovolemia, hypoTN)

Question 5

major cause of non-occlusive mesenteric ischemia

Answer 5

dehydration

Question 6

mechanism of gut ischemic injury

Answer 6

1. hypoxia, then 2. reperfusion induced superoxide radicals

Question 7

the first sign of intestinal ischemia is?

Answer 7

abdominal pain

Question 8

intestinal ischemia causes blood in the stool when?

Answer 8

necrosis of the surface epithelium leads to sloughing and hemorrhage

Question 9

ultimately, intestinal ischemia can progress to?

Answer 9

infarction/”acute abdomen” with signs of peritonitis

Question 10

the most common and often missed cause of intestinal ischemia is?

Answer 10

colonic ischemia

Question 11

presentation of ischemic colitis

Answer 11

crampy LLQ abdominal pain, hematochezia/bloody diarrhea, pain out of proportion

Question 12

risk factors for ischemic colitis

Answer 12

old age, cardiac, hypotensive state (dialysis, sepsis, etc), hypercoagulability

Question 13

colonic ischemia most frequently occurs in the?

Answer 13

watershed area

Question 14

dx of ischemic colitis

Answer 14

barium enema or colonoscopy shows “thumbprinting”, mucosal edema and erythema, hemorrhagic nodules, ulceration

Question 15

tx for ischemic colitis is usually _____, but may require ____ if fulminant or perforated

Answer 15

supportive care (saline); surgery & ABX

Question 16

acute mesenteric ischemia presents similarly to _____ and should be dx by _______

Answer 16

ischemic colitis (but not LLQ, often periumbilical); direct angiography (because you can tx right there)

Question 17

tx of acute mesenteric ischemia

Answer 17

antibiotics, infuse vasodilator tx into vasculature during dx

Question 18

what causes NOMI?

Answer 18

splanchnic vasoconstriction secondary to CV event that persists despite correction of underlying cause

Question 19

chronic mesenteric ischemia is like intestinal ____, which occurs after ____ (rather than exercise)

Answer 19

angina; eating

Question 20

sx of chronic mesenteric ischemia

Answer 20

abdominal peri-umbilical pain after eating, fear of eating, weight loss, nausea, diarrhea, bloating

Question 21

only true tx for chronic mesenteric ischemia

Answer 21

revascularization