Ischemic Bowel Disease

Question 1

Ischemic bowel dz from an acute arterial thrombosis is most likely to occur in the ________ artery

Answer 1

Superior Mesenteric a.

Question 2

Ischemic bowel dz due to a venous thrombosis is most likely to occur in the ____ veins

Answer 2

Superior/Inferior Mesenteric

Question 3

Pt with confirmed atherosclerosis in the presents with episodic HypoTN and stomach pain directly after eating. No symptoms of GERD or gastroduodenal ulcers. What else might this be?

Answer 3

Ischemic bowel disease and pain after eating due to not enough blood flow O2 to stomach

Question 4

_____ is the MC form of intestinal ischemia

Answer 4

Acute Colonic Ischemia

Question 5

Is the superior or inferior mesenteric artery more commonly occluded?

Answer 5

Superior

Question 6

Insane abd pain is most likely associated with ______

A. Arterial Occlusion
B. Venous Occlusion
C. Acute Colonic Ischemia (non-occlusive, low flow-state)

Answer 6

A. Arterial Occlusion

PANCE ALERT

Question 7

Insidious abd pain is most likely associated with _____

A. Arterial Occlusion
B. Venous Occlusion
C. Acute Colonic Ischemia (non-occlusive, low flow-state)

Answer 7

B. Venous Occlusion
Especially if mesenteric vein clot

Question 8

Which of the following has a hyperactive, paralytic, and shock phase?

A. Arterial Occlusion
B. Venous Occlusion
C. Acute Colonic Ischemia (non-occlusive, low flow-state)

Answer 8

C. Acute Colonic Ischemia

1. Hyperactive Phase -> severe colicky abd pain
2. Paralytic Phase -> absent bowel sounds
3. Shock Phase -> Dehydration, Metab Acidosis, Tachy

Question 9

Arterial occlusions are higher risk at ______ and _____ point due to poor blood flow

Answer 9

Griffith’s and Sudeck’s Point
* Griffith’s = Splenic Flexure
* Sudeck’s = Rectosigmoid junction

Question 10

What part of the bowels is MC affected by an acute mesenteric venous occlusion?

Answer 10

Ileum (64-83%)

Question 11

Study of choice for acute mesenteric artery occlusion?

Answer 11

CT angiogram

Question 12

Test of choice for acute mesenteric venous occlusion?

Answer 12

CT PO/IV Contrast (can see free air better)

if inconclusive -> CT Angio (talk to Rad about choice)

Question 13

Why cant you give vasopressors to someone with an acute mesenteric arterial occlusion?

Answer 13

Vasopressors contrict and will make occlusion worse

Question 14

Definitive trmnt for arterial clot causing ischemic bowel dz

Answer 14

Sx embolectomy

Question 15

Trmnt for venous occlusion causing ischemic bowel dz

Answer 15

Mild-Mod -> anticoagulants
Severe -> Sx exploration

Question 16

Study of choice for colonic ischemic bowel disease caused by non-occlusive, low flow state

Answer 16

CT PO/IV Contrast -> bowel edema and thickening

Question 17

Trmnt for acute colonic ischemia

Answer 17

Supportive care -> fluids, bowel rest, poss ABX
Most cases heal spon

Mild -> sigmoidoscopy or colonoscopy + Bx
Mod -> poss anticoagulants and vascular intervention
Severe -> Sx resection