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A. MLA Map Cardiovascular > Intestinal ischaemia > Flashcards

Intestinal ischaemia Flashcards

1
Q

Ischaemia is anything that reduces blood flow to a tissue, such as arterial vasospasm, arterial or venous occlusion. Is intestinal ischaemia acute or chronic?

A
  • both
  • can affect anywhere in the GIT
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2
Q

Which of the following is not a common risk factor for intestinal ischaemia?

1 - atrial fibrillation
2 - heart failure
3 - kidney failure
4 - alcohol
5 - prothrombotic condition
6 - age
7 - smoking

A

4 - alcohol

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3
Q

Acute ischaemia is a sudden restriction in blood to the GIT. How can an embolic event cause acute ischaemia?

1 - air bubble blocking a blood vessel in the GIT
2 - foreign body bubble blocking a blood vessel in the GIT
3 - blood clot bubble blocking a blood vessel in the GIT
4 - all of the above

A

4 - all of the above

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4
Q

Acute ischaemia is a sudden restriction in blood to the GIT. Which of the following does not generally cause acute ischaemia?

1 - embolic event
2 - thrombotic event
3 - hypertension
4 - volvulus of vessel

A

3 - hypertension

  • younger patients with cardiac issues are more likely to have venous ischaemia
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5
Q

Although the symptoms of acute ischaemia are broad, which one of the following is the best indicator of acute ischaemia?

1 - nausea/vomiting
2 - abdominal pain out of proportion with clinical findings
3 - post-rectal bleeding
4 - acidaemia

A

2 - abdominal pain out of proportion with clinical findings

  • especially if atrial fibrillation is present
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6
Q

If we suspect a patient has small bowel ischaemia we can run an ABG. What 3 markers would we expect to see changed in an ABG that would point to an acute ischaemia?

1 - raised Hb
2 - raised WBC
3 - increased lactate
4 - reduced pH
5 - increased pH
6 - high HCO3-

A

2 - raised WBC
3 - increased lactate
4 - reduced pH

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7
Q

If we suspect small bowel ischaemia we can use imaging. What might we see on an X-ray that is relevant to an acute ischaemia?

1 - dilated bowels and obstruction
2 - blocked blood vessels
3 - necrotic tissue
4 - GIT perforation

A

1 - dilated bowels and obstruction

  • may explain the underlying pathophysiology
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8
Q

If we suspect small bowel ischaemia we can use imaging. What imaging is best to image a patient with suspected acute ischaemia?

1 - ultrasound
2 - X-ray
3 - MRI with contrast
4 - CT scan with contrast

A

4 - CT scan with contrast

  • contrast must include arterial and venous phase contrast
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9
Q

If we suspect small bowel ischaemia we can use imaging. CT with contrast including arterial and venous phase contrast is best. Is the specificity equally good for small and large intestine?

A
  • no
  • better for small intestines
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10
Q

If we suspect a patient has small bowel ischaemia, what are the 2 conservative approaches that are arguably the most important from below that should be implemented?

1 - antibiotics
2 - IV fluids
3 - analgesia
4 - NG tube for decompression
5 - IV glucose

A

2 - IV fluids
4 - NG tube for decompression

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11
Q

If we suspect a patient has small bowel ischaemia and gangrene is present, what treatment should be implemented?

1 - surgical resection of gangrene tissue
2 - IV antibiotics
3 - oral antibiotics with IV fluids
4 - analgesia, IV antibiotics and fluids

A

1 - surgical resection of gangrene tissue

  • the others may happen, but removing gangrene tissue is most important
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12
Q

If we suspect a patient has small bowel ischaemia and gangrene is not present, what treatment should be implemented?

1 - surgery and resection of suspected ischaemic tissue
2 - IV fluids and NG tube for decompression
3 - heparinisation and/or thrombolysis
4 - analgesia, IV antibiotics and fluids

A

3 - heparinisation and/or thrombolysis

  • they others may also be used, but this is the most important
  • regardless of treatment the mortality is high
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13
Q

Ischemic colitis occurs when blood flow to part of the large intestine is temporarily reduced, meaning the metabolic demands of the colon are not met. This segment of the large intestine is called the colon. What is the incidence of this?

1 - 3/100,000
2 - 30/100,000
3 - 300/100,000
4 - 3000/100,000

A

2 - 30/100,000

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14
Q

Ischemic colitis occurs when blood flow to part of the large intestine is temporarily reduced, meaning the metabolic demands of the colon are not met. What can this cause?

1 - mucosal ulceration, inflammation, haemorrhage
2 - mucosal ulceration, inflammation, granuloma
3 - mucosal ulceration, polyps, haemorrhage
4 - granuloma, inflammation, haemorrhage

A

1 - mucosal ulceration, inflammation, haemorrhage

  • bleeding not always present, especially if ischaemia is severe
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15
Q

Which of the following is NOT a cause of acute ischemic colitis?

1 - heart failure
2 - atherosclerotic disease
3 - atrial fibrillation
4 - acute thrombosis
5 - medications (chemotherapy, NSAIDs, vasopressors)
6 - CKD
7 - previous aortic abdominal aneurysm

A

6 - CKD

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16
Q

Acute ischemic colitis can present in a variety of ways. What type of pain is generally present?

1 - generalised stabbing pain
2 - colicky abdominal pain
3 - isolated visceral pain in the flanks
4 - distended and generalised tenderness

A

2 - colicky abdominal pain

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17
Q

Why might we see diarrhoea and post rectal bleeding in a patient with suspected acute ischemic colitis?

1 - ulcers form causing blood with lack of fluid reabsorption
2 - epithelial is shedded causing blood and diarrhoea
3 - tissue becomes gangrene causing bleeding
4 - blood vessels become fragile and rupture

A

1 - ulcers form causing blood with lack of fluid reabsorption

  • colon is inflamed and cannot function properly, so we get diarrhoea
  • blood comes from ulcer formation
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18
Q

Which of the following is NOT a typical differential for someone with suspected acute ischemic colitis?

1 - IBD
2 - infective colitis
3 - diverticulitis
4 - volvulus

A

4 - volvulus

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19
Q

What imaging is most commonly used for patients with suspected acute ischemic colitis?

1 - ultrasound
2 - X-ray
3 - MRI with contrast
4 - CT scan with contrast

A

4 - CT scan with contrast

20
Q

Which site is acute ischemic colitis most likely to occur?

1 - caecum
2 - hepatic flexure
3 - splenic flexure
4 - sigmoid colon

A

3 - splenic flexure
- watershed area for blood flow, so most at risk

21
Q

In a patient with acute ischemic colitis, what % of patients are treated conservatively?

1 - 9%
2 - 29%
3 - 59%
4 - >90%

A

4 - >90%

22
Q

> 90% of patients with acute ischemic colitis are treated conservatively. Although they are typically resuscitated using IV fluids, they are also given an important drug. Which drug is likely to help patients the most?

1 - antibiotics
2 - analgesics
3 - anticoagulation therapy
4 - steroids

A

3 - anticoagulation therapy

  • anti-platelets don’t have much evidence
  • if it is severe and potentially gangrene, surgery is often required
23
Q

> 90% of patients with acute ischemic colitis are treated conservatively using anti-coagulants. What % of patients have a recurrence following treatment?

1 - <15%
2 - <30%
3 - <50%
4 - <70%

A

1 - <15%

24
Q

What is chronic mesenteric ischemia?

1 - embolic event
2 - plaque builds up in the major arteries
3 - thrombolytic event
4 - chronic hypertension

A

2 - plaque builds up in the major arteries

25
Q

Chronic mesenteric ischemia is when plaque builds up in the major arteries. Is this more common in men or women?

A
  • women at a 3:1 ratio
26
Q

The majority of patients who have chronic mesenteric ischemia is due to atherosclerosis. What % of >65 year olds have some form of stenosis of the coeliac or superior mesenteric arteries?

1 - 2%
2 - 20%
3 - 40%
4 - 70%

A

2 - 20%

  • often without symptoms
27
Q

What is the main cause of pain in a patient with chronic mesenteric ischemia?

1 - blood flow decrease during rest causing pain
2 - blood flow increases during fight or flight and causes pain
3 - following eating, blood flow to mesenteries is increased and causes pain

A

3 - following eating, blood flow to mesenteries is increased and causes pain

  • normally 15-30 minutes following a meal
  • can lead to weight loss for fear of pain when eating
28
Q

In patients with chronic mesenteric ischemia, what imaging modality is typically used?

1 - ultrasound
2 - X-ray
3 - MRI with contrast
4 - CT scan with contrast

A

4 - CT scan with contrast

  • can normally confirm stenosis
  • MRI angiography can be helpful
29
Q

In patients with chronic mesenteric ischemia, why can catheter angiography be useful?

A
  • diagnose and stent
  • medical management is to reduce risk factors
  • surgery may help revascularise
30
Q

Of the following arteries, which is most susceptible to acute bowel ischaemia?

1 - coeliac
2 - superior mesenteric artery
3 - middle colic artery
4 - inferior mesenteric artery

A

2 - superior mesenteric artery

31
Q

Where does the foregut begin and end?

1 - stomach to jejunum
2 - oesophagus to 2nd part of duodenum
3 - oesophagus to ileum
4 - stomach to 2nd part of duodenum

A

2 - oesophagus to 2nd part of duodenum

  • marked in duodenum by major duodenal papilla (papilla of Vater)
32
Q

The foregut is from the oesophagus to 2nd part of duodenum, marked in duodenum by major duodenal papilla (papilla of Vater). Which of the following is not part of the foregut?

1 - oesophagus
2 - stomach
3 - liver
4 - spleen
5 - gall bladder
6 - pancreas
7 - kidney
8 - 1st and 2nd part of duodenum

A

7 - kidney

33
Q

Where does the midgut begin and end?

1 - stomach to ileum
2 - 3rd part of duodenum to ceacum
3 - 3rd part of duodenum to proximal 2/3 of transverse colon
4 - jejunum to proximal 2/3 of transverse colon

A

3 - 3rd part of duodenum to proximal 2/3 of transverse colon

34
Q

Where does the hindgut begin and end?

1 - ileum to rectum
2 - ileum to caecum
3 - distal 1/3 of transverse colon to sigmoid colon
4 - distal 1/3 of transverse colon to rectum above pectinate line

A

4 - distal 1/3 of transverse colon to rectum above pectinate line

35
Q

The fore, mid and hindgut all receive their arterial blood supply from the abdominal aorta. Which of the following supplies the foregut?

1 - coeliac
2 - superior mesenteric artery
3 - middle colic artery
4 - inferior mesenteric artery

A

1 - coeliac
- at level T12

36
Q

The coeliac artery branches of the abdominal aorta at T12 and has 3 branches. Which of the following is NOT 1 of these 3 branches?

1 - common hepatic artery
2 - right gastric artery
3 - splenic artery
4 - left gastric artery

A

2 - right gastric artery

37
Q

The fore, mid and hindgut all receive their arterial blood supply from the abdominal aorta. Which of the following supplies the midgut?

1 - coeliac
2 - superior mesenteric artery
3 - middle colic artery
4 - inferior mesenteric artery

A

2 - superior mesenteric artery
- at level L1

38
Q

The superior mesenteric artery (SMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the SMA means it supplies the jejunum and ileum. What is the name of this group of arteries?

1 - iliocolic artery
2 - right colic artery
3 - jejunum and ileum arteries (arcades)
4 - middle colic artery

A

3 - jejunum and ileum arteries (arcades)

39
Q

The superior mesenteric artery (SMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the SMA means it supplies the terminal ileum, caecum and ascending colon. What is the name of this artery?

1 - iliocolic artery
2 - right colic artery
3 - jejunum and ileum arteries (arcades)
4 - middle colic artery

A

1 - iliocolic artery

  • also supplies the appendicular artery
40
Q

The superior mesenteric artery (SMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the SMA means it supplies the just the ascending colon retroperitoneally. What is the name of this artery?

1 - iliocolic artery
2 - right colic artery
3 - jejunum and ileum arteries (arcades)
4 - middle colic artery

A

2 - right colic artery

41
Q

The superior mesenteric artery (SMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the SMA means it supplies the transverse colon. What is the name of this artery?

1 - iliocolic artery
2 - right colic artery
3 - jejunum and ileum arteries (arcades)
4 - middle colic artery

A

4 - middle colic artery

42
Q

The fore, mid and hindgut all receive their arterial blood supply from the abdominal aorta. Which of the following supplies the hindgut?

1 - coeliac
2 - superior mesenteric artery
3 - middle colic artery
4 - inferior mesenteric artery

A

4 - inferior mesenteric artery
- at level L3

43
Q

The inferior mesenteric artery (IMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the IMA means it supplies the descending colon. What is the name of this artery?

1 - left colic artery
2 - sigmoid artery
3 - superior rectal artery
4 - marginal artery

A

1 - left colic artery

44
Q

The inferior mesenteric artery (IMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the IMA means it supplies the sigmoid and descending colon. What is the name of this artery?

1 - left colic artery
2 - sigmoid arteries
3 - superior rectal artery
4 - marginal artery

A

2 - sigmoid arteries

45
Q

The inferior mesenteric artery (IMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the IMA means it supplies the proximal rectum. What is the name of this artery?

1 - left colic artery
2 - sigmoid arteries
3 - superior rectal artery
4 - marginal artery

A

3 - superior rectal artery

46
Q

The inferior mesenteric artery (IMA) comes through the mesentery and heads towards the ileocaecal junction. One of the branches of the IMA means it supplies the distal 1rd of the transverse colon. What is the name of this artery?

1 - left colic artery
2 - sigmoid arteries
3 - superior rectal artery
4 - marginal arteries

A

4 - marginal arteries

A. MLA Map Cardiovascular (21 decks)

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