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DMST 343 Vascular 3 > Mesenteric Vasculature > Flashcards

Mesenteric Vasculature Flashcards

1
Q

Splanchnic arteries supply what area?

A

The bowel

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2
Q

What does the splanchnic arteries separate into? 3

A
  1. Celiac
  2. Superior mesenteric artery
  3. Inferior mesenteric artery
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3
Q

Where is the splanchnic artery located in relation to the aorta?

A

Anterior wall

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4
Q

What is the first branch off the aorta?

A

Celiac

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5
Q

What dies the celiac divides into? 3

A
  1. The left gastric
  2. Splenic
  3. COmmon hepatic arteries
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6
Q

What does the celiac artery supply? 5

A
  1. Stomach
  2. Liver
  3. Pancreas
  4. Duodenum
  5. Spleen
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7
Q

What is the Doppler signal of celiac artery? 2

A

Low resistance
1. PSV 50-160 cm/sec
2. EDV < 55cm/s
Waveform more important then numbers

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8
Q

Where is the SMA located?

A

1 to 2 cm distal to the celiac artery

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9
Q

The SMA and celiac occasional share what?

A

Common trunk

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10
Q

What does the SMA supply? 4

A
  1. Small intestine
  2. Caecum
  3. Ascending colon
  4. Part of the transverse colon
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11
Q

SMA flow varies with what?

A

Metabolic activity of the gut

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12
Q

What is the Fasting SMA waveform like? 2

A
  1. Higher resistance with occasional reverse component (multiphasic)
  2. PSV varies between 110-177cm/s
    waveform more important than numbers
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13
Q

What does the SMA look like post prandially?

A

Low resistance with increased velocities

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14
Q

Where is the IMA located? 2

A
  1. Distal aorta
  2. 3-4 cm superior to the bifurcation
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15
Q

What does the IMA supply? 4

A
  1. Left half of transverse colon
  2. Descending iliac
  3. Sigmoid colon
  4. Part of the rectum
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16
Q

How easy is it to image the IMA?

A

Difficult to image, but easy visualization of the IMA may suggest SMA occlusion

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17
Q

What does the pancreaticoduodenal arcade link?

A

Links celiac and SMA via arterial branches that surround the duodenum and pancreas

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18
Q

What does the arc of rimland and marginal artery of Drummond link? 2

A
  1. The IMA and SMA via mesenteric arterial branches
  2. Left colic- middle artery is common branch for collateralization in this group
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19
Q

In terms of the arc of Roland, because of the potential for collateralization, the splanchnic arterial occlusion is often asymptomatic or symptomatic?

A

Asymptomatic

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20
Q

What are indications for duplex testing? 3

A
  1. Suspected chronic ischemia (CMI)
  2. Median arcuate ligament syndrome (MALS)
  3. Undergone prior mesenteric intervention - stents bypass grafts
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21
Q

What does stenosis/ occlusion cause?

A

Acute or chronic bowel ischemia, but often prevented with collateralization.

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22
Q

What do we assess in we suspect stenosis?

A

Assess the aorta documenting any narrowing or aneurysmal disease that may encroach on the origins of the celiac and mesenteric vessels prior to assessing them

23
Q

What is the gold standard for diagnosing stenoses?

A

Arteriography

24
Q

What does doppler look like in a fasting state? 4

A
  1. Stenosis causing >70% diameter reduction
  2. Celiac artery - PSV of >200cm/s
  3. SMA- PSV >275 cm/s
  4. IMA- no PSV parameters
25
Q

In terms of doppler of stenosis, what is the ratio of the artery PSV over PSV?

A

PSV > 3.5 indicates a stenosis >70%

26
Q

Occlusion of the CA may indirectly be considered when what happens?

A

Reversal of flow is seen in the gastroduodenal or common hepatic arteries

27
Q

Who/What might we see with post-prandial pain with chronic mesenteric ischemia? 3

A
  1. Weight loss
  2. Smoking history
  3. Women 40-70 most common
28
Q

What do we see with acute mesenteric ischemia?

A

Sudden onset of abdominal symptoms, usually progresses to life threatening conditions due to bowel necrosis

29
Q

What is acute mesenteric ischemia caused by?

A

Embolus to the mesenteric arteries or thrombosis of an arter with existing chronic disease

30
Q

IS acute mesenteric ischemia emergency?

A

Yes surgical

31
Q

What is the preferred method of diagnosis for acute mesenteric ischemia?

A

CT/Angiography

32
Q

What is the most common demographic affected by Median arcuate ligament syndrome? 4

A
  1. Younger
  2. <40
  3. Females
  4. History months to years of upper abdominal pain, not necessarily smokers, almost always thin
33
Q

What is MALS?

A

Transient compression of the celiac artery origin by the median arcuate ligament of the diaphragm during exhalation, which is relieved or decreased during exhalation

34
Q

What is treatment for MALS?

A

Laparoscopic release of the median arcuate ligament

35
Q

What does MALS look like with U/S? 2

A
  1. Celiac artery PSV increases during exhalation and decrease during inhalation
  2. 2D of proximal celiac artery typically demonstrates a characteristic “hooked” apeparrence
36
Q

In terms of the CMI, what is the waveform in a fasting state normally?

A

Normally in a fasting state the waveform is high resistance

37
Q

In terms of CMI, patents are scanned when?

A

Pre and post prandially

38
Q

20-30 minutes after the patient is scanned for CMI, what happens? 2

A
  1. The patient has been given a high caloric liquid mean, the study is repeated, or sooner if the patient becomes asymptomatic
  2. Hemodynamics responses are than compared from both states
39
Q

In terms of CMI, what would result in not doing another test? What re post prandial velocities of the SMA and IMA?

A
  1. Low resistance, high PSV in a fasting patient is a positive finding and no need to test post prandially
  2. Post prandial velocities in the SMA and IMA remain very high
40
Q

In terms of CMI, evaluating flow changes pre and post prandially is what type of test?

A

Exercise stress test

41
Q

In terms of CMI, evaluation of bowel ischemia with sonography is made more difficult as what?

A

Bowel ischemia is not always due to disease in the main celiac and mesenteric arteries

42
Q

In terms of CMI, Ischemia may be due to what? 4

A

Other causes such as
1. Hypotension
2. Small vessel disease
3. Emboli
4. Venous obstruction

43
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45
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46
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47
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48
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49
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50
Q

When would we feel pain in terms of chronic mesenteric ischemia?

A

Post prandial

51
Q

What do we need to use to see chronic mesenteric ischemia?

A

Angiography

52
Q

In terms of Chronic mesenteric ischemia, how many arteries must be involved with atherosclerosis?

A

2-3

53
Q

Why is it challenging to diagnose chronic mesenteric ischemia?

A

The extensive amount of collaterals that may develop

DMST 343 Vascular 3 (7 decks)

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