Mesenteric Ischemia, Raynauds, Lymphedema

Question 1

Pathology of mesenteric ischemia

Answer 1

Intestinal ischemia caused by any process that reduces intestinal blood flow

Question 2

RF for mesenteric ischemia

Answer 2

Any condition that reduces perfusion of intestines + predisposes to mesenteric arterial embolism, thrombosis or vasoconstriction

Question 3

S+S of mesenteric ischemia

Answer 3

Abdo pain out of proportion to physical exam

Can be after eating

Question 4

Diagnosis of mesenteric ischemia

Answer 4

CT angiography without contrast

Question 5

Management of mesenteric ischemia

Answer 5

Anticoagulation to restore blood flow

Arterial embolectomy, arterial bypass, arterial stenting, thrombolysis, vasodilator infusion

Question 6

What is Raynauds?

Answer 6

Exaggerated vasoconstrictive response to cold temp and emotional stress

Question 7

What is secondary Raynauds?

Answer 7

Raynauds with presence of related illness such as SLE or sclerosis, Takayasu’s arteritis

Question 8

How is Raynauds diagnosed?

Answer 8

Positive answers to 3 questions:
•Are your fingers unusually sensitive to cold?
•Do your fingers change color when they are exposed to cold temperatures?
•Do your fingers turn white, blue, or both?

Question 9

What factors may cause suspicion of secondary Raynauds?

Answer 9

• Later age of onset
• History of a known precipitant
• Male gender
• Painful severe events with tissue sign of ischemia (ulceration)
• Asymmetric attacks
• RP associated with signs or symptoms of another disease
• Abnormal nailfold capillaries
• Abnormal laboratory parameters suggesting vascular disease or an autoimmune disorder
• RP associated with ischemic signs or symptoms proximal to the fingers (such as the hand or arm) or toes (foot or limb)

Question 10

What is lymphoedema?

Answer 10

Progressive disorder of lymphatic system with accumulation of interstitial fluid

Question 11

S+S of lymphoedema

Answer 11

Extremity swelling, skin changes, limb pain + discomfort, restricted ROM, nonpitting edema

Question 12

What is Raynauds phenomenon vs syndrome?

Answer 12

Phenomenon = affects fingers + toes symmetrically, severity remains constant 
Syndrome = asymmetrical, progressive severity

Question 13

What is the management of Raynauds?

Answer 13

Vasodilators eg CCB

Surgery to cut sympathetic nerve fibres to affected areas