Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD1 GI - EXAM 1 > Ischémie intestinale > Flashcards

Ischémie intestinale Flashcards

1
Q

What is the anatomy of splanchnic circulation? (3 “axes”)

A
  1. Axe coeliaque (at D12)
  2. Axe mésentérique supérieur (at L1)
  3. Axe mésentérique inférieur (at L3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the axe coeliaque split into?

A

A. gastrique g., a. hépatique commune, a. splénique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where does the axe coeliaque supply blood?

A

Stomach, duodenum, pancreas, liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does the axe mésentérique supérieur split into? (5)

A

a. pancréatico-duodénale antérieure, a. pancréatico-duodénale postéro-inf., a. colique d., a. colique moyenne, a. iléocoliques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does the axe mésentérique supérieur supply blood?

A

pancreas, duodenum, small inststin, colon d. and transverse proximal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the axe mésentérique inférieur split into? (3)

A

a. colique g., branges sigmoïdiennes, a. rectale supérieure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where does the axe mésentérique inférieur supply blood?

A

colon transverse distal, colon gm sigmoïde, rectum proximal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Overview of splanchnic circulation:

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is the duodenum vascularized? (weird case)

A

Proximal:

  • a. gastroduodénale (a. hépatique commune —> tronc coeliaque)
  • branches pancréaticoduodénales

Distal:

  • Branches pancréaticudiodénales —> AMS

Branches pancréaticoduodénales venant du t. coeliaque et AMS s’anastomosent —> suppléance en cas de thrombose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Veinous return of small instestine:

A

Veinules circulent dans mésentère —> v. mésentérique supérieure (VMS)

VMS + v. splénique = v. porte (VP)

Après avoir traversé le foie, sang retourne à circulation via:

  • v. sus-hépatiques —> v. cave inférieur —> OD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the four kinds of intestinal ischemia?

A
  1. Ischémie mésentérique aiguë
  2. Ischémie mésentérique chronique
  3. Ischémie colique
  4. Colite ischémique

Can originate from arteries or veins and can be acute or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main causes of ischémique mésentérique aiguë? (3 kinds)

A

Arterial (most common in AMS)

  • AMS embolism (50%)
  • AMS thrombosis (10%)

Veinous (VMS or VP)

  • Thrombosis (10%) —> vasculitis, FA, pro-coagulation

Non-occlusive ischemia (25%):

  • Severe hypotension, hypovolemia, heart failure
  • Arrhythmia, cocaine, vasoactive Rx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the main causes of thrombose veineuse mésentérique? (6)

A
  • Thrombophilies (pro-coag)
  • Inflammation affecting organ that touches vessel (ex: appendicitis, diverticulitis, pancreatis, MII (maladies inflammatoires intestinales))
  • Portal hypertension/cirrhosis
  • Post-abdominal trauma
  • Pregnancy
  • Cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some clinical manifestations of ischémique mésentérique aiguë?

A

Sudden and severe abdominal pain (diffuse)

Nausea/vomiting

Rapid evolution towards —> peritoneal irritation, perforation (défense localisé —> diffuse —> ventre de bois)

Sepsis and fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some investigations used to dx ischémique mésentérique aiguë?

A

Leucocytose —> neutrophiles

Metabolic acidosis with increased lactates (delayed indication of a severe condition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What forms of imagery can be used to dx ischémique mésentérique aiguë?

A

Abdominal X-Ray (non-dx)

  • Iléus grêle “thumbprinting”
  • Intestinal pneumatosis
  • Air libre —> perforation du viscère

TDM/angio-TDM: better one

  • exclude other causes of acute abdominal pain
  • angioTDM: pathologies vasculaires/l’état de l’intestin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is thumbprinting?

A

radiographic sign of large bowel wall thickening, usually caused by edema, related to an infective or inflammatory process (colitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ddx for intestinal ischemia (8)

A
  1. Acute pancreatitis
  2. Rupture d’un viscère creux
  3. Dissection/rupture d’un AAA (aneurysm of aorta)
  4. Cholangitis (bile duct system inflammation)
  5. Cholecystitis (inflammation of the gallbladder)
  6. Renal colic
  7. Sub-occlusion
  8. Appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What forms of treatment ischémique mésentérique aiguë?

A

Medical: usually works if done early in evolution —> avoid necrosis

  • Ressuscitation volémique, broad spectrum antibiotics (edema can lead to translocation of bacteria to the blood)
  • Reperméabilisation des vaisseaux: héârine ou thrombectomie

Surgical: if intestinal necrosis

  • Emergency laparotomy to resect necrotic sections
  • Most common in AMS “territory”: intestin moyen + distal et colon proximal
20
Q

What is the mortality rate of ischémie mésentérique aiguë?

A

70-90% if dx made after necrosis has started —> dx early to act fast

21
Q

What is ischémie mésentérique chronique?

A

Also known as “angine mésentérique”

22
Q

What is the blood flow to the intestines?

A

20% du débit cardiaque en période basale et 35% post prandiale

23
Q

What causes ischémie mésentérique chronique?

A

Most often: mesenteric atherosclerosis

  • arterial supply to viscera is insufficient
  • O2 is brought to viscera by 3 principal vessels (tronc coeliaque, AMS and AMI)… if atherosclerosis in 2/3 —> angine mésentérique
24
Q

What are some clinical manifestations of ischémie mésentérique chronique?

A

Pain: peri-umbilical/epigastric, post-prandial/proportional to size of meal… will lead to weight loss due to pt restricting intake to dim. sx

  • Sx similar to cardiac angina —> inc. if theres effort… in this case, effort = digestion
25
Q

Signs during physical examination of ischémie mésentérique chronique:

A

Souffle épigastrique… otherwise not very specific or important

26
Q

How to diagnose angine mésentérique?

A

Pretty difficult…. must first eliminate other ddx

Must have: Sx cliniques typiques + occlusion ≤ 2 a. splanchniques show by:

  • Doppler
  • Angiographie via CT-Scan
  • IRM
  • Arterial catheter… VERY INVASIVE —> RARELY USED
27
Q

How is angine mésentérique treated?

A

Revascularization (restore perfusion): tuteur endovasculaire (stent), pontage aorto-coeliaque et AMS si bon candidat pour chx

28
Q

Which arteries irrigate the right part of the colon?

A

Branches de AMS

29
Q

Which arteries irrigate the left and sigmoid parts of the colon?

A

AMI

30
Q

Which arteries irrigate the transverse colon?

A

AMS and AMI —> 2 apports en connection par l’a. marginale de Drummond

31
Q

Which arteries irrigate the angle splénique?

A

extrémité des territoires d’irrigation des 2 a. mésentériques —> Zone de Watershed

32
Q

Which arteries irrigate the rectum?

A

a. rectale supérieure (issue de l’AMI)
a. rectales moyennes et inférieures (issues d’a. ilique interne)

33
Q

Overview of colonic circulation:

A
34
Q

Which veins irrigate each part of the colon?

A

Les veins suivent les artères

VMS et VMI —> VP

a. rectales moyennes et inférieures —> v. iliaques internes

35
Q

What is colite ischémique?

A

mostly in right colon

associated with isch. mésentérique

most common form of intestinal ischemia

urgence et dx difficile et tx difficile

REMEMBER:

If colon d. touchée —> think to exclude isch. mésentérique associée (atteinte de l’AMS)

36
Q

Which vessels are associated with colite ischémique?

A

mésentériques supérieurs

37
Q

What is the most common form of ischémie colique?

A

Colite isch. transitoire —> no tx available

38
Q

What causes colite ischémique?

A

Reduction in arterial flow to colon (usually AMI) due to vascular occlusion (arthéromatose, artérite, embolie) or dim. in débit de perfusion (hypovolémie, choc, déshydratation)

39
Q

What are some risk factors for colite ischémique?

A

Frequency increases with age

Pt-type: personne âgée avec facteurs de risque CV (HTA, DB, DLPD, MCAS, MVAS —> vaisseaux malades)

If young patient (< 40): cocaine, vasculitis, thrombophilias, marathons (hypovolémie), rx (oral contraceptives, AINS) or obstructive lesions

40
Q

What areas are at risk for colite ischémique?

A

Zones de watershed: watershed area is the medical term referring to regions of the body that receive dual blood supply from the most distal branches of two large arteries

ex: angle splénique (AMS + AMI), angle recto-sigmoïdien (AMI + a. rectales)

41
Q

What is the typical clinical presentation of colite ischémique?

A

Dlrs abdo. subites —> diarrhea containing blood

Light fever

RARE: only if severe colitis —> signes de péritonisme (inflammation du péritoine)

42
Q

How is colite ischémique dx?

A

TDM —> zones de colite

Colonoscopie: atteinte segmentaire (usually splénique/sigmoide), erythème avec érosions, muqueuse bleutée (isch), voire noirâtre, hémorragies sous-épithéliales, zones nécrotiques

43
Q

How is colite ischémique tx?

A

Support: solute for hydration with anesthetic if in pain, observation for 48-72 hrs, optimize FDR, transfusion PRN if necessary

If transmural involvement with severe colitis —> antibiotics to dim. risk of bacterial translocation

Chx/ressection colique au besoin: VERY RARE —> if perforation or uncontrollable bleeding… usually due to severe necrosis

44
Q

How is the evolution of colite ischémique?

A

Quite favourable… isolated and non repetitive

Healing usually complete without complications (rare delayed complications —> stenosis)

45
Q

Why and how would you go about doing supplementary investigations for colite ischémique?

A

If < 40 and no FDR…

  • Echographie cardiaque
  • ECG
  • Abdominal Doppler
  • Holter
  • Bilan de coagulation

MD1 GI - EXAM 1 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions