URR Mesenteric Vessels

Question 1

what are the vessels included in a mesenteric exam?

Answer 1

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

Question 2

what 3 vessels does the celiac split into?

Answer 2

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

Question 3

what kind of resistance does the celiac have?

Answer 3

lowly resistive

Question 4

does flow change in the celiac after eating?

Answer 4

NO

Question 5

what are the norm velocities for celiac?

Answer 5

PSV < 2.0 m/sec

Question 6

where is the celiac in relation to the panc?

Answer 6

superior to panc body

Question 7

what are abnorm values for the celiac?

Answer 7

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

Question 8

what is the smallest branch of the celiac?

Answer 8

left gastric

Question 9

how does the left gastric travel from the celiac?

Answer 9

anterior and cephalad

Question 10

what does the left gastric supply flow to?

Answer 10

stomach and pylorus

Question 11

what is the right branch of the celiac artery?

Answer 11

common hepatic artery

Question 12

what does the common hepatic artery supply blood flow to?

Answer 12

liver, GB, and stomach

Question 13

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

Answer 13

superior to panc head

Question 14

how is the resistance in the common hepatic artery?

Answer 14

lowly resistive

Question 15

the common hepatic artery branches into what artery?

Answer 15

proper hepatic artery

Question 16

the proper hepatic artery enters where?

Answer 16

liver and gastroduodenal artery that supplies the panc and duodenum

Question 17

the hepatic artery supplies how much blood to the liver?

Answer 17

20-30%

Question 18

what are the 2 variants of the hepatic artery?

Answer 18

-originates from SMA
-originates from Ao

Question 19

what implies portal hypertension in the hepatic artery?

Answer 19

RI > .78

Question 20

what is the largest branch of the celiac artery?

Answer 20

splenic artery

Question 21

where is the splenic artery in relation to the panc?

Answer 21

post to panc body and prox to tail

Question 22

what is the most tortuous artery in the body?

Answer 22

splenic artery

Question 23

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

Answer 23

splenic artery

Question 24

what is the resistance in the splenic artery?

Answer 24

lowly resistive

Question 25

where is the splenic artery on the celiac artery?

Answer 25

left side

Question 26

the SMA supplies blood to what?

Answer 26

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

Question 27

how is resistance in the SMA?

Answer 27

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

Question 28

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

Answer 28

stenosis

Question 29

where does the IMA originate?

Answer 29

3-4 cm above the Ao bif

Question 30

what does the IMA provide blood to?

Answer 30

dist colon and prox rectum

Question 31

what resistance does the IMA have?

Answer 31

high resistance

Question 32

if the IMA is easily identified what is happening?

Answer 32

usually means its dilated meaning SMA stenosis

Question 33

what is mesenteric ischemia?

Answer 33

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

Question 34

what are the symptoms for mesenteric ischemia?

Answer 34

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

Question 35

how to do exam for mesenteric ischemia?

Answer 35

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

Question 36

treatment for mesenteric ischemia?

Answer 36

angioplasty, stent, bypass

Question 37

what is median arcuate ligament syndrome?

Answer 37

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

Question 38

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

Answer 38

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

Question 39

what is SMA syndrome (Wilkie Syndrome)?

Answer 39

-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