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Vascular Boards > URR Mesenteric Vessels > Flashcards

URR Mesenteric Vessels Flashcards

1
Q

what are the vessels included in a mesenteric exam?

A

-prox abdominal ao
-celiac
-common hepatic A
-splenic artery
-SMA
-IMA

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2
Q

what 3 vessels does the celiac split into?

A

-common hepatic artery (CHA)
-left gastric
-splenic artery

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3
Q

what kind of resistance does the celiac have?

A

lowly resistive

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4
Q

does flow change in the celiac after eating?

A

NO

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5
Q

what are the norm velocities for celiac?

A

PSV < 2.0 m/sec

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6
Q

where is the celiac in relation to the panc?

A

superior to panc body

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7
Q

what are abnorm values for the celiac?

A

-PSV > 2.0 m/sec indicates 70-99% stenosis
-EDV > .55 m/sec indicates >50%

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8
Q

what is the smallest branch of the celiac?

A

left gastric

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9
Q

how does the left gastric travel from the celiac?

A

anterior and cephalad

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10
Q

what does the left gastric supply flow to?

A

stomach and pylorus

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11
Q

what is the right branch of the celiac artery?

A

common hepatic artery

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12
Q

what does the common hepatic artery supply blood flow to?

A

liver, GB, and stomach

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13
Q

where is the common hepatic artery in relation to the panc?

A

superior to panc head

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14
Q

how is the resistance in the common hepatic artery?

A

lowly resistive

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15
Q

the common hepatic artery branches into what artery?

A

proper hepatic artery

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16
Q

the proper hepatic artery enters where?

A

liver and gastroduodenal artery that supplies the panc and duodenum

17
Q

the hepatic artery supplies how much blood to the liver?

A

20-30%

18
Q

what are the 2 variants of the hepatic artery?

A

-originates from SMA
-originates from Ao

19
Q

what implies portal hypertension in the hepatic artery?

A

RI > .78

20
Q

what is the largest branch of the celiac artery?

A

splenic artery

21
Q

where is the splenic artery in relation to the panc?

A

post to panc body and prox to tail

22
Q

what is the most tortuous artery in the body?

A

splenic artery

23
Q

which vessel is the most common site for an aneurysm on a visceral vessel?

A

splenic artery

24
Q

what is the resistance in the splenic artery?

A

lowly resistive

25
Q

where is the splenic artery on the celiac artery?

A

left side

26
Q

the SMA supplies blood to what?

A

the jejunum, ileum, cecum, ascending colon, duodenum, and panc head

27
Q

how is resistance in the SMA?

A

-pre-eating: high resistance, peaked waveform
-post eating : low resistance, rounded waveform
PSV can increase after eating

28
Q

if no resistance changes occur in the SMA what is happening?

A

stenosis

29
Q

where does the IMA originate?

A

3-4 cm above the Ao bif

30
Q

what does the IMA provide blood to?

A

dist colon and prox rectum

31
Q

what resistance does the IMA have?

A

high resistance

32
Q

if the IMA is easily identified what is happening?

A

usually means its dilated meaning SMA stenosis

33
Q

what is mesenteric ischemia?

A

diagnosed with stenosis/occlusion of 2 or more of the 3 major arteries which supply the small bowel and colon ( Celiac, SMA, IMA)

34
Q

what are the symptoms for mesenteric ischemia?

A

patient experiences reproducible pain after eating due to bowel ischemia caused by stenosis

35
Q

how to do exam for mesenteric ischemia?

A

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

36
Q

treatment for mesenteric ischemia?

A

angioplasty, stent, bypass

37
Q

what is median arcuate ligament syndrome?

A

-intermittent extrinsic compression of Celiac
-caused by diaphragm moving superior and the median arcuate ligament pinching the celiac

38
Q

what happens in median arcuate ligament syndrome during patient inspiration and expiration?

A

-may see pain with expiration
-increased PSV in celiac with respiration
-velocities will increase with expiration and return to norm on inspiration

39
Q

what is SMA syndrome (Wilkie Syndrome)?

A

-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

Vascular Boards (33 decks)

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