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VASC 4 > Mesenteric Vasculature > Flashcards

Mesenteric Vasculature Flashcards

1
Q

What do the splanchnic arteries supply?

A

Bowel

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2
Q

What are the 3 splanchnic arteries?

A

celiac artery, superior mesenteric artery, inferior mesenteric artery

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3
Q

What is the first branch off the aorta?

A

Celiac artery

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4
Q

What does the celiac artery divide into?

A

Left gastric, splenic, and common hepatic arteries

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5
Q

What does the celiac artery supply?

A

Stomach, liver, pancreas, duodenum, spleen

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6
Q

What is a celiac artery waveform resistance like?

A

Low resistance

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7
Q

What is the normal PSV of the celiac artery? EDV?

A

50-160 cm/sec; <55 cm/sec

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8
Q

Where does the SMA originate?

A

1-2 cm distal to the celiac artery

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9
Q

What 2 vessels often share a common trunk?

A

SMA and celiac

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10
Q

What does the SMA supply?

A

Small intestine, cecum, ascending colon, transverse colon

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11
Q

What is the waveform like in the SMA with fasting?

A

High resistance with occasional reverse component

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12
Q

What is the normal PSV of the SMA with fasting?

A

110-177 cm/sec

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13
Q

Where does the inferior mesenteric artery originate?

A

3-4 cm superior and to the left of the aortic bifurcation

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14
Q

What does the IMA supply?

A

Left half of transverse colon, descending, iliac, and sigmoid colon, part of the rectum

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15
Q

What may easy visualization of the IMA suggest?

A

SMA occlusion

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16
Q

What are the major collateral pathways of the mesenteric vasculature?

A

Pancreaticoduodenal arcade, Arc of Riolen, marginal artery of Drummond

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17
Q

What does the pancreaticoduodenal artery do?

A

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

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18
Q

What do the Arc of Riolan and marginal artery of Drummond do?

A

Link IMA and SMA via mesenteric arterial branches

19
Q

What collateral pathway connects the IMA and SMA?

A

Arc of Riolan and marginal artery of Drummond

20
Q

What collateral pathway connects the celiac and SMA?

A

Pancreaticoduodenal arcade

21
Q

Why is splanchnic arterial occlusion often asymptomatic?

A

Collateralization

22
Q

What can a stenosis or occlusion cause?

A

Acute or chronic bowel ischemia

23
Q

How is acute or chronic bowel ischemia often prevented?

A

Collateralization

24
Q

What should be done before assessing the mesenteric vessels?

A

Scan aorta to document any narrowing or aneurysmal disease

25
Q

What is the gold standard for diagnosing stenoses?

A

Arteriography

26
Q

What is the diameter reduction of a stenosis that is hemodynamically significant?

A

> /= 70%

27
Q

What is a normal PSV for the IMA?

A

It does not have specific values

28
Q

What is a PSV suggesting stenosis in a celiac artery?

A

> /= 200 cm/s

29
Q

What is a PSV suggesting stenosis in the SMA?

A

> /= 275 cm/sec

30
Q

What is an abnormal PSV of the artery/PSV of the aorta in a stenosis?

A

> 3.5 (indicates stenosis >70%)

31
Q

What are some indirect signs of occlusion of the CA?

A

Reversal of flow in the gastroduodenal or common hepatic arteries

32
Q

What are 2 causes of stenosis of the CA?

A

Atherosclerosis, compression of CA by median arcuate ligament of the diaphragm

33
Q

What is acute mesenteric ischemia?

A

Sudden onset of abdominal symptoms due to an embolic process that progresses to a life threatening condition

34
Q

What are the 2 symptoms of acute mesenteric ischemia?

A

Pain, intestinal angina

35
Q

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

A

CT/angio

36
Q

What is chronic mesenteric ischemia characterized by?

A

Post-prandial pain (after eating) which leads to patient changing their dietary content and habits

37
Q

What is necessary to diagnose chronic mesenteric ischemia?

A

At least 2 major arteries to the bowel have atherosclerosis

38
Q

What is the CA blood flow like post-prandially in chronic mesenteric ischemia?

A

Not affected

39
Q

When are patients scanned with chronic mesenteric ischemia?

A

Pre and post prandially

40
Q

What are the mesenteric arteries waveforms like in a fasting state with chronic mesenteric ischemia?

A

High resistance

41
Q

What would normally happen to the mesenteric arteries after eating?

A

PSV and EDV increase (EDV almost doubles)

42
Q

What would happen to the mesenteric arteries after eating with chronic mesenteric ischemia?

A

Velocities remain high

43
Q

What would happen to the mesenteric arteries before eating with chronic mesenteric ischemia?

A

Low resistance pattern with high velocities

44
Q

What are some causes of mesenteric ischemia asides from atherosclerosis?

A

Hypotension, small vessel disease, emboli, or venous obstruction

VASC 4 (6 decks)

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