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GI & Liver Fall 2013 CBD > Path Ischemic and Vascular GI disorders > Flashcards

Path Ischemic and Vascular GI disorders Flashcards

1
Q

SMA branches

A

Right & left colic
jejunal branches
ileal branches
ileocolic loop

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2
Q

how does vascular resistance increase in intramural vasculature?

A

precapillary sphincters

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3
Q

3 hormones that cause vasoconstrictions in GI & their sources

A

catecholamines, adrenal medulla
angiotensin II, Renal JGA
vasopressin Post. pituitary

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4
Q

3 hormones that cause vasorelaxation in GI & their sources

A

gastrin, G cells
CCK, I cells
Secretin, S cells

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5
Q

main intra-celular system responsible for vasodilation

A

NO

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6
Q

main mechanism for vasoconstriction

A

IP3 (phosphoinositol-inosotol triphosphate)

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7
Q

ileus-sepsis

A

infarction

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8
Q

edema of lamina propria

A

pain w/o ileus

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9
Q

necrosis of villi - presentation

A

bleeding

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10
Q

3 categories of vascular disorders

A

mucosal, mural, transmural

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11
Q

ischemic colitis

presentation, dx, tx, outcome, comments

A

Presentation: hematochezia, diarrhea, abdom pain (mild 2/10), abd tenderness

Dx: abdominal CT, colonoscopy

Tx: conservative

Outcome: benign

Comments: Look for splenic flexure in watershed region

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12
Q

ileus: early or late sign?

A

late

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13
Q

Acute mesenteric ischemia

presentation, dx, tx, outcome, comments

A

Presentation: early abdominal pain w/o ileus. peritoneal pain only in advanced disease. +/- hematochezia

Dx: abdominal CT, XR, MRI. Angiography (high Sn/Sp) Look for “Thumb indention” in XR

Tx: ICU mgmt, vasodilators, surg

Outcome: badness

Comments: medical/surgical emergency -> necrosis.

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14
Q

Bowel infarct

presentation, dx, tx, outcome, comments

A

Presentation: sequelae of ischemia

Dx: “dusky bowel” in surg.

Tx: resect

Outcome: bad. resect.

Comments: “dusky bowel” look for curtain of hemorrhage indicating edge of necrosis/indicating depth.

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15
Q

Chronic ischemia

presentation, dx, tx, outcome, comments

A

Presentation: abdominal pain after eating

Dx: CT, MRI, US, angiography

Tx: angioplasty/stent/surg

Outcome:

Comments: at least 2/3 splanchnic arteries usually have significant occlusive disease.

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16
Q

venous mesenteric ischemia

presentation, dx, tx, outcome, comments

A

Presentation: in several days

Dx: CT, MRI, angiography

Tx: stent/surg/anticoag meds

Outcome:

Comments: associated w/hypercoagulability status

17
Q 
GI bleeding
(presentation types)
A

melena - above ligament of Treitz

hematochezia - below ligament of Treitz

18
Q

Ischemic colitis vs acute mesenteric ischemia

A

Ischemic Colitis: <60 yo, acute cases rare, mild pain, tenderness, bleeding, colonoscopy.

Acute mesenteric ischemia: any age, acute cause, severe pain, tenderness not prominent early, bleeding uncommon, angiography

19
Q

Acute upper GI bleeding

presentation, dx, tx, outcome, comments

A

Presentation: men/elderly,

Dx: scope

Tx: surg/scope to close

Outcome: 80% self-limiting. mortality dependent on cause. recurrence = 30% mortality risk.

Comments: most frequent GI bleed.

20
Q

obscure overt bleeding

obscure occult bleeding

A

you see blood, but not source

you see no blood or source

21
Q

low risk of rebleeding in ulcer on scope?

highest risk for rebleeding?

A

white base, away from large vessels lowest risk.

active bleeding highest risk. proximity to duodenal bulb bad b/c big vessels.

22
Q

Esophageal Varices

presentation, dx, tx, outcome, comments

A

Presentation:

Dx:

Tx: banding

Outcome: mortality 30-50%. pressure, size, color are predictive.

Comments:

23
Q

Mallory-Weiss tear

presentation, dx, tx, outcome, comments

A

Presentation: longitudinal tear at hiatal area

Dx: scope

Tx: hemodynamic stabilization and endoscopic treatment. Angiography or surgery are rarely required.

Outcome: resolves w/conservative mgmt. Bleeding stops spontaneously in 80-90%. 5% rebleed.

Comments: from retching.

24
Q

acute lower GI bleed

outcome
acute causes
chronic causes

A

Outcome: mortality 3.6%

Chronic causes: hemorrhoids & neoplasia
Acute causes: Diverticulosis and angiodysplasia

25
Q

Angiodysplasia

presentation, comments

A

Presentation: older, chronic renal failure, Ssler-Weber-Rendu, prior radiation therapy, watermelon stomach (GAVE) slow intermittent blood loss.

Comments:
primarily at cecum (37%)) & right colon (17%), sigmoid (18%)

26
Q 
appearance of esophageal ulcers:
GERD
pill-induced
CMV
herpes
A

GERD watermelon? red
pill-induced - spot anywhere
CMV - anywhere, large, same color as mucosa, ischemic
herpes - at GE junction

27
Q

Define:
Osler-Weber-Rendu
Watermelon Stomach (GAVE)

A

autosomal dominant skin & mucosal disorder

gastric angiovascular ectasia/watermelon stomach

GI & Liver Fall 2013 CBD (16 decks)

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