Mesenteric Ischemia

Question 1

What percentage of the blood supply is splanchnic

Answer 1

25% (increased to 35% post-prandially)

Question 2

What is the key in decreasing mortality in acute mesenteric ischemia

Answer 2

prompt diagnosis and tx

Question 3

How is mesenteric ischemia classically described

Answer 3

pain out of proportion to exam

Question 4

What is the gold standard imaging for acute mesenteric ischemia

Answer 4

aortogram

Question 5

What is the MC site of acute embolism

Answer 5

SMA-origin of the middle colic artery

Question 6

What is a good intermediate therapy for patients presenting within 8 hours of mesenteric ischemia

Answer 6

thrombolytic therapy

Question 7

MC imaging performed for mesenteric ischemia

Answer 7

CTA

Question 8

Define NOMI: non-occlusive mesenteric ischemia

Answer 8

clinical syndrome that does not result from a fixed stenosis or occlusion but results from hypoperfusion of the intestinal viscera

Question 9

What can cause NOMI

Answer 9

hypovolemia, under-resuscitation, vasopressor therapy

Question 10

Definitive dx of NOMI is by

Answer 10

angiography

Question 11

What are the findings in NOMI on angiography

Answer 11

spasm of the SMA and branches without a focal occlusion

Question 12

Tx of NOMI

Answer 12

tx the underlying illness, papverine infusion and discontinue vasopressors

Question 13

What causes mesenteric venous thrombosis

Answer 13

vascular congestion due to poor venous outflow

Question 14

What is the classic history of patients with chronic mesenteric ischemia

Answer 14

angina brought on by ingesting food -resulting in food fear

Question 15

What arteries are usually effected in chronic mesenteric ischemia

Answer 15

celiac axis, common hepatic, SMA

Question 16

Tx options for chronic mesenteric ischemia

Answer 16

EVAR + angioplasty, stenting or bypass

Question 17

Post op imaging following surgical repair of chronic mesenteric ischemia

Answer 17

abdominal duplex