GI Vascular Diseases Flashcards

1
Q

What is the primary learning objective regarding gastrointestinal anatomy and physiology?

A

Apply previous knowledge to understand vascular compromise within the gastrointestinal system.

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2
Q

What are the three types of mesenteric ischemia that need to be differentiated?

A

Acute mesenteric ischemia, chronic mesenteric ischemia, colonic ischemia.

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3
Q

What is the primary artery supplying the foregut?

A

Celiac artery.

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4
Q

What is the primary artery supplying the midgut?

A

Superior mesenteric artery (SMA).

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5
Q

What is the primary artery supplying the hindgut?

A

Inferior mesenteric artery (IMA).

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6
Q

What percentage of cardiac output does the splanchnic circulation receive under basal conditions?

A

25%.

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7
Q

What percentage of splanchnic flow goes to the mucosa?

A

70%.

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8
Q

What causes ischemic injury in the gastrointestinal tract?

A

Hypoxemia and reperfusion injury.

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9
Q

What is the mortality rate associated with acute mesenteric ischemia?

A

> 50%.

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10
Q

What is the most common cause of acute mesenteric ischemia?

A

SMA embolism (50%).

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11
Q

What are the complications of acute mesenteric ischemia?

A

Infarction, metabolic acidosis, peritonitis, cardiovascular collapse.

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12
Q

What is the classic clinical presentation of mesenteric artery embolism?

A

Severe, acute abdominal pain out of proportion to physical exam findings.

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13
Q

What imaging technique is considered the gold standard for diagnosing mesenteric artery conditions?

A

Mesenteric angiography.

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14
Q

What is the primary treatment for mesenteric artery embolism?

A

Rapid restoration of blood flow.

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15
Q

What condition is characterized by decreased venous blood flow leading to ischemia?

A

Mesenteric venous thrombosis.

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16
Q

What is the gold standard for diagnosing mesenteric venous thrombosis?

A

CT with IV contrast.

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17
Q

What is a common clinical presentation of chronic mesenteric ischemia?

A

Postprandial abdominal pain.

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18
Q

What is the primary cause of chronic mesenteric ischemia?

A

Atherosclerotic narrowing of 2 out of 3 major vessels.

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19
Q

What is the most common cause of colonic ischemia?

A

Nonocclusive ischemia.

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20
Q

What is the typical clinical presentation of colonic ischemia?

A

Abrupt onset LLQ pain followed by hematochezia.

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21
Q

What are angiodysplasias?

A

Aberrant blood vessels causing chronic, intermittent, painless bleeding.

22
Q

What is the gold standard for diagnosing angiodysplasias?

A

Angiography.

23
Q

What is gastric antral vascular ectasia also known as?

A

Watermelon stomach.

24
Q

What is the clinical presentation of a Dieulafoy lesion?

A

Massive acute arterial bleed.

25
Q

Fill in the blank: The treatment for mesenteric venous thrombosis with infarction is _______.

A

Emergent laparotomy to restore flow and resect necrotic bowel.

26
Q

True or False: Chronic mesenteric ischemia often presents with acute symptoms.

27
Q

Where is a Dieulafoy lesion usually located?

A

Upper stomach/lesser curvature

Can occur anywhere along GIT

28
Q

What is the cause of Dieulafoy lesions?

A

Unknown, possibly congenital

29
Q

What is a common clinical presentation of a Dieulafoy lesion?

A

Massive acute arterial bleed, brisk upper GI bleed leading to hematochezia

30
Q

Who is most likely to be affected by Dieulafoy lesions?

A

Usually men with cardiovascular comorbidities

31
Q

How is a Dieulafoy lesion diagnosed?

A

Visualize vessel with upper endoscopy, possibly using a Doppler probe

32
Q

What treatment options are available for Dieulafoy lesions?

A

Epinephrine injections, cautery, tattoo, hemoclip, surgery (wedge resection) if refractory

33
Q

What are some other vascular lesions mentioned?

A
  • Vascular tumors
  • Hemangiomas
  • Kaposi sarcoma
  • Angiosarcoma
  • Radiation-induced vascular ectasias
34
Q

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?

A

Acute mesenteric ischemia

35
Q

What other clinical findings or lab values are likely to be seen with the patient presenting with acute mesenteric ischemia?

A

leukocytosis; red currant-jelly stools

36
Q

What additional medication should a patient with a history of hypertension, diabetes, and atrial fibrillation be taking?

A

Pt. should also be taking anticoagulants like Warfarin

37
Q

What does the CHA2DS2-VASc score assess?

A

Stroke risk in patients with atrial fibrillation

38
Q

What factors contribute to the CHA2DS2-VASc score? List them.

A
  • CHF: 1
  • HTN: 1
  • Age ≥ 75: 2
  • DM: 1
  • Prior stroke/TIA/thromboembolism: 2
  • Vascular disease: 1
  • Age 65-75: 1
  • Sex category: 1
39
Q

What is the most likely diagnosis for a 79-year-old male with progressively worsening abdominal pain after eating and weight loss?

A

Chronic mesenteric ischemia

40
Q

What is the pathophysiology of chronic mesenteric ischemia?

A

Narrowed, atherosclerotic intestinal vessels

41
Q

What does a positive stool guaiac indicate?

A

Possible gastrointestinal bleeding

42
Q

What lab results are indicative of iron deficiency anemia in an 83-year-old female?

A

Hgb 9.5 g/dL and MCV 75 fL

43
Q

What is the next appropriate step after diagnosing iron deficiency anemia?

A

Stool Guaiac

44
Q

Is treatment necessary for iron deficiency anemia?

45
Q

What other pathology should be looked for in a patient with iron deficiency anemia?

A

atherosclerosis & CKD

46
Q

What is a key takeaway regarding intestinal ischemia?

A

Various presentations are important to recognize to reduce morbidity and mortality

47
Q

What is a common cause of gastrointestinal bleeding in aging populations?

A

Vascular lesions

48
Q

What are risk factors for angiodysplasia

A

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

49
Q

How is GAVE Histologically defined

A

a form of arteriosclerosis:
fibro-hyalinosis: thickening of arterial wall by deposits of pink hyaline

50
Q

What are the clinical characteristics of a D. Lesion?

A

commonly seen in older men w/ CVD comorbidities
usually located in the upper stomach regions
described as an eroded artery