URR Mesenteric Vessels Flashcards
what are the vessels included in a mesenteric exam?
-prox abdominal ao
-celiac
-common hepatic A
-splenic artery
-SMA
-IMA
what 3 vessels does the celiac split into?
-common hepatic artery (CHA)
-left gastric
-splenic artery
what kind of resistance does the celiac have?
lowly resistive
does flow change in the celiac after eating?
NO
what are the norm velocities for celiac?
PSV < 2.0 m/sec
where is the celiac in relation to the panc?
superior to panc body
what are abnorm values for the celiac?
-PSV > 2.0 m/sec indicates 70-99% stenosis
-EDV > .55 m/sec indicates >50%
what is the smallest branch of the celiac?
left gastric
how does the left gastric travel from the celiac?
anterior and cephalad
what does the left gastric supply flow to?
stomach and pylorus
what is the right branch of the celiac artery?
common hepatic artery
what does the common hepatic artery supply blood flow to?
liver, GB, and stomach
where is the common hepatic artery in relation to the panc?
superior to panc head
how is the resistance in the common hepatic artery?
lowly resistive
the common hepatic artery branches into what artery?
proper hepatic artery
the proper hepatic artery enters where?
liver and gastroduodenal artery that supplies the panc and duodenum
the hepatic artery supplies how much blood to the liver?
20-30%
what are the 2 variants of the hepatic artery?
-originates from SMA
-originates from Ao
what implies portal hypertension in the hepatic artery?
RI > .78
what is the largest branch of the celiac artery?
splenic artery
where is the splenic artery in relation to the panc?
post to panc body and prox to tail
what is the most tortuous artery in the body?
splenic artery
which vessel is the most common site for an aneurysm on a visceral vessel?
splenic artery
what is the resistance in the splenic artery?
lowly resistive
where is the splenic artery on the celiac artery?
left side
the SMA supplies blood to what?
the jejunum, ileum, cecum, ascending colon, duodenum, and panc head
how is resistance in the SMA?
-pre-eating: high resistance, peaked waveform
-post eating : low resistance, rounded waveform
PSV can increase after eating
if no resistance changes occur in the SMA what is happening?
stenosis
where does the IMA originate?
3-4 cm above the Ao bif
what does the IMA provide blood to?
dist colon and prox rectum
what resistance does the IMA have?
high resistance
if the IMA is easily identified what is happening?
usually means its dilated meaning SMA stenosis
what is mesenteric ischemia?
diagnosed with stenosis/occlusion of 2 or more of the 3 major arteries which supply the small bowel and colon ( Celiac, SMA, IMA)
what are the symptoms for mesenteric ischemia?
patient experiences reproducible pain after eating due to bowel ischemia caused by stenosis
how to do exam for mesenteric ischemia?
eval CA, splenic a, common hepatic, p-d SMA, IMA, Ao
-give high caloric meal
-scan As again
-SMA and IMA should have decreased resistance if norm
treatment for mesenteric ischemia?
angioplasty, stent, bypass
what is median arcuate ligament syndrome?
-intermittent extrinsic compression of Celiac
-caused by diaphragm moving superior and the median arcuate ligament pinching the celiac
what happens in median arcuate ligament syndrome during patient inspiration and expiration?
-may see pain with expiration
-increased PSV in celiac with respiration
-velocities will increase with expiration and return to norm on inspiration
what is SMA syndrome (Wilkie Syndrome)?
-if patient suffers from severe weight loss, fatty tissue around SMA is diminished, causing acute angulation and reduction in the distance between Ao and SMA
-causes compression and obstruction of the 3rd part of the duodenum
-usually requires surgery
-can have abd pain and vomiting
