Sketchy Path: Intestinal Ischemia and Angiodysplasia

Question 1

What part of the bowel is spared at first from ischemia? What happens to there histology?

Answer 1

Crypts
Become hyperplastic
(proliferative plants on grave yard crypt)

Question 2

What effects does edema due to ischemia have on the bowel wall?

Answer 2

Increase pressure decreases venous return even further furthering the hypoperfusion

Question 3

Acute occlusion is most likely to occur in what branch of the aorta to the GI system?

Answer 3

SMA

Intestine on ship is black and necrotic

Question 4

What should you suspect in a patient with an irregularly irregular rhythm with acute abdominal pain?

Answer 4

Clot from the left side of the heart has broken off and is now occluding the SMA
(AFib TV on top of SMA boat)

Question 5

A patient with acute mesenteric ischemia commonly presents with what symptom?

Answer 5

Pain out of proportion to the PE

Green wrestler in back screaming and holding stomach

Question 6

As ischemia develops in patient what will happen to the PE?

Answer 6

Loss of bowel sounds due to ileus

Broken speaker

Question 7

What are some complications that can arise from acute mesenteric ischemia?

Answer 7

Perforation

Sepsis

Question 8

Ischemia in the large bowel usually has what type of pathophysiology?

Answer 8

Hypoperfusion to the watershed areas

Water shed port a potty

Question 9

Why is the large bowel not affected as much during occlusive disorders?

Answer 9

Since the large bowel has many anastomoses it is not affected by occlusion as much
(trees above water shed look like anastomosing arteries)

Question 10

Cardiogenic shock can cause what type of ischemia?

Answer 10

Colonic Ischemia

Guy pouring out water bucket with heart on his shirt

Question 11

What is the most common form of intestinal ischemia?

Answer 11

Colonic ischemia due to hypoperfusion (low BP state)

Question 12

What are the two watershed areas of the colon?

Answer 12

Splenic Flexure
Distal end of sigmoid colon
(colon is attached to tree at these areas)

Question 13

Colonic ischemia causes pain on what side of the abdomen?

Answer 13

Left since both watershed areas are there

Question 14

What symptoms are seen with ischemic colitis?

Answer 14

Bloody diarrhea
Loss of bowel sounds
(broken speaker in water shed and bloody pool on floor)

Question 15

What are complications of acute colonic ischemia?

Answer 15

Gangrene
Sepsis
(Septic shock man hole cover)

Question 16

Chronic ischemia of the GI system most commonly occurs where?

Answer 16

Small bowel

Chronic Mesenteric Ischemia

Question 17

Chronic Mesenteric Ischmeia is also called what?

Answer 17

Intestinal Angina

anvil sitting near grandfather clock on the SB side of sketch

Question 18

What is the major cause of chronic mesenteric ischemia?

Answer 18

atherosclerosis of the mesenteric artery

Pipe with yellow plaques on the inside

Question 19

When do people with chronic mesenteric ischemia feel pain?

Answer 19

Post-prandial

guy eating painful burrito and is in pain

Question 20

What is angiodyspalsia of the GI tract?

Answer 20

Dilated malformed blood vessels that are only composed of endothelium
(women in cecum costume holding skeleton by blood vessel strings)

Question 21

What is the most common presenting symptom of angiodysplasia?

Answer 21

Painless Hematochezia

girl dressed as colon with puppet standing in blood

Question 22

An association exist between bleeding angiodysplasia and what other pathology?

Answer 22

Aortic Stenosis

Angiodysplasia girl wearing the witches aortic stenosis hat

Question 23

What population is most likely to have chronic mesenteric ischemia?

Answer 23

Women over 50 who smoke

women smoking and cooking on the angina anvil