Sketchy Path: Intestinal Ischemia and Angiodysplasia Flashcards
What part of the bowel is spared at first from ischemia? What happens to there histology?
Crypts
Become hyperplastic
(proliferative plants on grave yard crypt)
What effects does edema due to ischemia have on the bowel wall?
Increase pressure decreases venous return even further furthering the hypoperfusion
Acute occlusion is most likely to occur in what branch of the aorta to the GI system?
SMA
Intestine on ship is black and necrotic
What should you suspect in a patient with an irregularly irregular rhythm with acute abdominal pain?
Clot from the left side of the heart has broken off and is now occluding the SMA
(AFib TV on top of SMA boat)
A patient with acute mesenteric ischemia commonly presents with what symptom?
Pain out of proportion to the PE
Green wrestler in back screaming and holding stomach
As ischemia develops in patient what will happen to the PE?
Loss of bowel sounds due to ileus
Broken speaker
What are some complications that can arise from acute mesenteric ischemia?
Perforation
Sepsis
Ischemia in the large bowel usually has what type of pathophysiology?
Hypoperfusion to the watershed areas
Water shed port a potty
Why is the large bowel not affected as much during occlusive disorders?
Since the large bowel has many anastomoses it is not affected by occlusion as much
(trees above water shed look like anastomosing arteries)
Cardiogenic shock can cause what type of ischemia?
Colonic Ischemia
Guy pouring out water bucket with heart on his shirt
What is the most common form of intestinal ischemia?
Colonic ischemia due to hypoperfusion (low BP state)
What are the two watershed areas of the colon?
Splenic Flexure
Distal end of sigmoid colon
(colon is attached to tree at these areas)
Colonic ischemia causes pain on what side of the abdomen?
Left since both watershed areas are there
What symptoms are seen with ischemic colitis?
Bloody diarrhea
Loss of bowel sounds
(broken speaker in water shed and bloody pool on floor)
What are complications of acute colonic ischemia?
Gangrene
Sepsis
(Septic shock man hole cover)
Chronic ischemia of the GI system most commonly occurs where?
Small bowel
Chronic Mesenteric Ischemia
Chronic Mesenteric Ischmeia is also called what?
Intestinal Angina
anvil sitting near grandfather clock on the SB side of sketch
What is the major cause of chronic mesenteric ischemia?
atherosclerosis of the mesenteric artery
Pipe with yellow plaques on the inside
When do people with chronic mesenteric ischemia feel pain?
Post-prandial
guy eating painful burrito and is in pain
What is angiodyspalsia of the GI tract?
Dilated malformed blood vessels that are only composed of endothelium
(women in cecum costume holding skeleton by blood vessel strings)
What is the most common presenting symptom of angiodysplasia?
Painless Hematochezia
girl dressed as colon with puppet standing in blood
An association exist between bleeding angiodysplasia and what other pathology?
Aortic Stenosis
Angiodysplasia girl wearing the witches aortic stenosis hat
What population is most likely to have chronic mesenteric ischemia?
Women over 50 who smoke
women smoking and cooking on the angina anvil
