Mesenteric Vasculature

Question 1

What do the splanchnic arteries supply?

Answer 1

Bowel

Question 2

What are the 3 splanchnic arteries?

Answer 2

celiac artery, superior mesenteric artery, inferior mesenteric artery

Question 3

What is the first branch off the aorta?

Answer 3

Celiac artery

Question 4

What does the celiac artery divide into?

Answer 4

Left gastric, splenic, and common hepatic arteries

Question 5

What does the celiac artery supply?

Answer 5

Stomach, liver, pancreas, duodenum, spleen

Question 6

What is a celiac artery waveform resistance like?

Answer 6

Low resistance

Question 7

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

Answer 7

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

Question 8

Where does the SMA originate?

Answer 8

1-2 cm distal to the celiac artery

Question 9

What 2 vessels often share a common trunk?

Answer 9

SMA and celiac

Question 10

What does the SMA supply?

Answer 10

Small intestine, cecum, ascending colon, transverse colon

Question 11

What is the waveform like in the SMA with fasting?

Answer 11

High resistance with occasional reverse component

Question 12

What is the normal PSV of the SMA with fasting?

Answer 12

110-177 cm/sec

Question 13

Where does the inferior mesenteric artery originate?

Answer 13

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

Question 14

What does the IMA supply?

Answer 14

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

Question 15

What may easy visualization of the IMA suggest?

Answer 15

SMA occlusion

Question 16

What are the major collateral pathways of the mesenteric vasculature?

Answer 16

Pancreaticoduodenal arcade, Arc of Riolen, marginal artery of Drummond

Question 17

What does the pancreaticoduodenal artery do?

Answer 17

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

Question 18

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

Answer 18

Link IMA and SMA via mesenteric arterial branches

Question 19

What collateral pathway connects the IMA and SMA?

Answer 19

Arc of Riolan and marginal artery of Drummond

Question 20

What collateral pathway connects the celiac and SMA?

Answer 20

Pancreaticoduodenal arcade

Question 21

Why is splanchnic arterial occlusion often asymptomatic?

Answer 21

Collateralization

Question 22

What can a stenosis or occlusion cause?

Answer 22

Acute or chronic bowel ischemia

Question 23

How is acute or chronic bowel ischemia often prevented?

Answer 23

Collateralization

Question 24

What should be done before assessing the mesenteric vessels?

Answer 24

Scan aorta to document any narrowing or aneurysmal disease

Question 25

What is the gold standard for diagnosing stenoses?

Answer 25

Arteriography

Question 26

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

Answer 26

>/= 70%

Question 27

What is a normal PSV for the IMA?

Answer 27

It does not have specific values

Question 28

What is a PSV suggesting stenosis in a celiac artery?

Answer 28

>/= 200 cm/s

Question 29

What is a PSV suggesting stenosis in the SMA?

Answer 29

>/= 275 cm/sec

Question 30

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

Answer 30

>3.5 (indicates stenosis >70%)

Question 31

What are some indirect signs of occlusion of the CA?

Answer 31

Reversal of flow in the gastroduodenal or common hepatic arteries

Question 32

What are 2 causes of stenosis of the CA?

Answer 32

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

Question 33

What is acute mesenteric ischemia?

Answer 33

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

Question 34

What are the 2 symptoms of acute mesenteric ischemia?

Answer 34

Pain, intestinal angina

Question 35

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

Answer 35

CT/angio

Question 36

What is chronic mesenteric ischemia characterized by?

Answer 36

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

Question 37

What is necessary to diagnose chronic mesenteric ischemia?

Answer 37

At least 2 major arteries to the bowel have atherosclerosis

Question 38

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

Answer 38

Not affected

Question 39

When are patients scanned with chronic mesenteric ischemia?

Answer 39

Pre and post prandially

Question 40

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

Answer 40

High resistance

Question 41

What would normally happen to the mesenteric arteries after eating?

Answer 41

PSV and EDV increase (EDV almost doubles)

Question 42

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

Answer 42

Velocities remain high

Question 43

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

Answer 43

Low resistance pattern with high velocities

Question 44

What are some causes of mesenteric ischemia asides from atherosclerosis?

Answer 44

Hypotension, small vessel disease, emboli, or venous obstruction