GI Vascular Diseases Flashcards
What is the primary learning objective regarding gastrointestinal anatomy and physiology?
Apply previous knowledge to understand vascular compromise within the gastrointestinal system.
What are the three types of mesenteric ischemia that need to be differentiated?
Acute mesenteric ischemia, chronic mesenteric ischemia, colonic ischemia.
What is the primary artery supplying the foregut?
Celiac artery.
What is the primary artery supplying the midgut?
Superior mesenteric artery (SMA).
What is the primary artery supplying the hindgut?
Inferior mesenteric artery (IMA).
What percentage of cardiac output does the splanchnic circulation receive under basal conditions?
25%.
What percentage of splanchnic flow goes to the mucosa?
70%.
What causes ischemic injury in the gastrointestinal tract?
Hypoxemia and reperfusion injury.
What is the mortality rate associated with acute mesenteric ischemia?
> 50%.
What is the most common cause of acute mesenteric ischemia?
SMA embolism (50%).
What are the complications of acute mesenteric ischemia?
Infarction, metabolic acidosis, peritonitis, cardiovascular collapse.
What is the classic clinical presentation of mesenteric artery embolism?
Severe, acute abdominal pain out of proportion to physical exam findings.
What imaging technique is considered the gold standard for diagnosing mesenteric artery conditions?
Mesenteric angiography.
What is the primary treatment for mesenteric artery embolism?
Rapid restoration of blood flow.
What condition is characterized by decreased venous blood flow leading to ischemia?
Mesenteric venous thrombosis.
What is the gold standard for diagnosing mesenteric venous thrombosis?
CT with IV contrast.
What is a common clinical presentation of chronic mesenteric ischemia?
Postprandial abdominal pain.
What is the primary cause of chronic mesenteric ischemia?
Atherosclerotic narrowing of 2 out of 3 major vessels.
What is the most common cause of colonic ischemia?
Nonocclusive ischemia.
What is the typical clinical presentation of colonic ischemia?
Abrupt onset LLQ pain followed by hematochezia.
What are angiodysplasias?
Aberrant blood vessels causing chronic, intermittent, painless bleeding.
What is the gold standard for diagnosing angiodysplasias?
Angiography.
What is gastric antral vascular ectasia also known as?
Watermelon stomach.
What is the clinical presentation of a Dieulafoy lesion?
Massive acute arterial bleed.
Fill in the blank: The treatment for mesenteric venous thrombosis with infarction is _______.
Emergent laparotomy to restore flow and resect necrotic bowel.
True or False: Chronic mesenteric ischemia often presents with acute symptoms.
False.
Where is a Dieulafoy lesion usually located?
Upper stomach/lesser curvature
Can occur anywhere along GIT
What is the cause of Dieulafoy lesions?
Unknown, possibly congenital
What is a common clinical presentation of a Dieulafoy lesion?
Massive acute arterial bleed, brisk upper GI bleed leading to hematochezia
Who is most likely to be affected by Dieulafoy lesions?
Usually men with cardiovascular comorbidities
How is a Dieulafoy lesion diagnosed?
Visualize vessel with upper endoscopy, possibly using a Doppler probe
What treatment options are available for Dieulafoy lesions?
Epinephrine injections, cautery, tattoo, hemoclip, surgery (wedge resection) if refractory
What are some other vascular lesions mentioned?
- Vascular tumors
- Hemangiomas
- Kaposi sarcoma
- Angiosarcoma
- Radiation-induced vascular ectasias
What is the most likely diagnosis for a 68-year-old male with sudden severe periumbilical abdominal pain, nausea, and a history of cardiovascular issues?
Acute mesenteric ischemia
What other clinical findings or lab values are likely to be seen with the patient presenting with acute mesenteric ischemia?
leukocytosis; red currant-jelly stools
What additional medication should a patient with a history of hypertension, diabetes, and atrial fibrillation be taking?
Pt. should also be taking anticoagulants like Warfarin
What does the CHA2DS2-VASc score assess?
Stroke risk in patients with atrial fibrillation
What factors contribute to the CHA2DS2-VASc score? List them.
- CHF: 1
- HTN: 1
- Age ≥ 75: 2
- DM: 1
- Prior stroke/TIA/thromboembolism: 2
- Vascular disease: 1
- Age 65-75: 1
- Sex category: 1
What is the most likely diagnosis for a 79-year-old male with progressively worsening abdominal pain after eating and weight loss?
Chronic mesenteric ischemia
What is the pathophysiology of chronic mesenteric ischemia?
Narrowed, atherosclerotic intestinal vessels
What does a positive stool guaiac indicate?
Possible gastrointestinal bleeding
What lab results are indicative of iron deficiency anemia in an 83-year-old female?
Hgb 9.5 g/dL and MCV 75 fL
What is the next appropriate step after diagnosing iron deficiency anemia?
Stool Guaiac
Is treatment necessary for iron deficiency anemia?
Yes
What other pathology should be looked for in a patient with iron deficiency anemia?
atherosclerosis & CKD
What is a key takeaway regarding intestinal ischemia?
Various presentations are important to recognize to reduce morbidity and mortality
What is a common cause of gastrointestinal bleeding in aging populations?
Vascular lesions
What are risk factors for angiodysplasia
OWR Syndrome (rare AD disease): absence of capillary beds b/t intestinal arterioles & venules; Scleroderma
CKD: uremia induced platelet dysfunction
Aortic Stenosis: acquired Von Will disease
How is GAVE Histologically defined
a form of arteriosclerosis:
fibro-hyalinosis: thickening of arterial wall by deposits of pink hyaline
What are the clinical characteristics of a D. Lesion?
commonly seen in older men w/ CVD comorbidities
usually located in the upper stomach regions
described as an eroded artery