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Surgery > Vascular 2 > Flashcards

Vascular 2 Flashcards

1
Q

Gangrenous Ischemic colitis

severe acute ischemia of the large bowel resulting in ___

A

infarction

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2
Q

Nongangrenous Ischemic colitis

hypoperfusion of the large bowel

Management?

A

Conservative

Mostly transient and self-limiting

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3
Q

Acute mesenteric ischemia

acute inadequate blood flow to the ___ bowel (arterial or venous) that can result in bowel infarction

A

small

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4
Q

Chronic mesenteric ischemia

constant OR episodic hypoperfusion of the small intestine, usually due to

A

atherosclerosis

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5
Q

Causes of Ischemic colitis:

  1. Thromboembolism (a-fib, IE)
  2. Hypovolemia (dehydration, hemorrhage)
  3. Vasoconstrictive drugs
    4.
A 
Cardiovascular surgery
(Aortic repairs & cardiac bypass)
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6
Q

Sites at High risk for compromise in Ischemic colitis (2)

because they are “watershed areas”

A

Splenic flexure

Rectosigmoid junction

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7
Q

Clinical features of Ischemic colitis:

  1. Hyperactive phase
    - Sudden onset of ___ abdominal pain
    - ____ stools
  2. Shock phase (rare)
    - _____
A

Crampy
Loose, Bloody

Peritonitis
(rebound/guarding)

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8
Q

In severe ischemic colitis labs can show:
↑ ___, ___, Creatinine Kinase
Leukocytosis

A

Lactate

LDH

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9
Q

Imaging for suspected Ischemic colitis

First line:

Confirmatory:

A

KUB: abdominal x-ray
(air-filled, distended bowel)

CT scan
(wall thickening, air in intestine walls)

Thumbprint sign: edematous thickening of the mucosa causes indentations in the large bowel wall

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10
Q

Mild-Moderate Ischemic colitis

  • No specific laboratory finding
  • Procedure of choice in moderate cases =
    Colonoscopy ( edema, cyanosis, +/- ulceration)

Management of mild-moderate sxs:

A

Conservative:
IVF, NPO, +/- NGT
Antiplatelet +/- Anticoagulation therapy

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11
Q

Definitive management of Ischemic colitis with signs of sepsis and peritoneal irritation?

A

Ex-lap

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12
Q

postprandial mismatch between splanchnic blood flow and intestinal metabolic demand → postprandial pain
Diagnosis:

A

Chronic Mesenteric Ischemia

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13
Q 
Clinical features
Crampy abdominal/intestinal angina
Recurrent, dull, postprandial epigastric pain ~within the first hour after eating
a fear of eating → weight loss
Diagnosis:
A

Chronic Mesenteric Ischemia

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14
Q

Chronic Mesenteric Ischemia
Imaging:
Treatment:

A

CT-Angiography

Frequent, small low-fat meals 
Revascularization surgery (if severe)
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15
Q

Acute Mesenteric Ischemia typically caused by what

A

Atrial Fibrillation → arterial embolism

SMA (∼ 90% of cases)

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16
Q

A patient with ____ typically presents with severe abdominal pain (usually periumbilical) fever, +/-bloody diarrhea, leukocytosis, ↑ Lactate.

Typically h/o a-fib

A

Acute Mesenteric Ischemia

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17
Q

A patient with ____ typically has a known cardiovascular or peripheral vascular disease and/or symptoms of chronic mesenteric ischemia in addition to the acute symptoms.

A

Acute arterial thrombosis

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18
Q

confirmatory test for Acute Mesenteric Ischemia

A

CT-Angiography

  • wall thickening
  • distended bowel with black flecks and stripes aka Pneumatosis Intestinalis (suggests transmural ischemia or infarction)
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19
Q

Treatment of Acute Mesenteric Ischemia
1. Bowel rest +

Definitive management:

  1. hemodynamically unstable: ___
  2. hemodynamically stable patients w/o signs of advanced ischemia: ___

Long-term measures:
Statin therapy
____ therapy

A

IVFs, NGT, NPO + ABxs

  1. Ex-Lap for (unstable, peritonitic, or septic)
    - Embolectomy mechanically
    - Bypass of artery
  2. Endovascular revascularization (stable)
    - Angioplasty + Stenting
    - Catheter-based Heparin (thrombolytics) or mechanical thrombectomy

Anticoagulation (for long-term)

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20
Q

Bilaterally absent femoral, popliteal, and ankle pulses
Pain in both legs and the buttocks
Erectile dysfunction

A

Leriche syndrome (aortoiliac occlusive disease)

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21
Q 
Leriche syndrome (aortoiliac occlusive disease)
sxs (3)
A

bilateral absent LE pulses
pain in legs/butt
erectile dysfunction

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22
Q

Acute limb ischemia
Best initial test: ____
Confirmatory test: ____

A

Doppler U/S (arterial & venous)

Angiography (CTA, MRA, DSA*)

*Digital subtraction angiography

23
Q

Treatment of Acute limb ischemia due to thromboembolism:

A

IV heparin bolus followed by continuous infusion

24
Q

Treatment of Acute limb ischemia s/p anticoagulation:

A

Angiography → Revascularization

25
Q

Treatment of Acute limb ischemia s/p HEPARIN ANTICOAGULATION :

  1. Threatened limb
    Emergent (w/in 6hr) ____
  2. Non-viable limb
    Limb amputation
A

Revascularization via
Catheter-directed Thrombolysis

*(or percutaneous Thromboembolectomy)

26
Q

Contraindication to cardiac catheterization

A

Acute renal failure

27
Q

Risk factors for Thoracic aortic aneurysm:
[PMH]
Smoking
Trauma
[Congenital]
[s/t obliterative endarteritis in vasa vasorum]

Connective tissue diseases (Marfan syndrome, Ehlers-Danlos syndrome)

A

Arterial HTN

Bicuspid aortic valve (Turner syndrome)

Tertiary syphilis

28
Q

Descending thoracic aortic aneurysm: typically 2/2 ____

A

atherosclerosis

29
Q

Pt presents with raspy voice and feeling like food gets stuck in his chest causing pressure & now back pain.

Suspected Diagnosis?

A

Thoracic aortic aneurysm

+/- sxs of mediastinal compression/obstruction:

  • Difficulty swallowing (esophagus)
  • Upper venous congestion (SVC syndrome)
  • Hoarseness (recurrent laryngeal nerve)
30
Q

Best confirmatory test for Thoracic aortic aneurysm

A

CT angiography chest

initial CXR may show widened mediastinum

31
Q

Conservative management for Thoracic aortic aneurysm (3)

A

Antihypertensives
Smoking cessation
Statins

32
Q

Clinical features of ruptured TAA:
__ rupture → Severe chest pain
__ rupture →Possible loss of consciousness

A

Contained

Free

33
Q

Procedure Indications:

Degenerative or traumatic descending aortic aneurysms

A

Thoracic endovascular aneurysm repair (TEVAR)

34
Q

Type of surgery for:

  1. Ascending Thoracic Aortic Aneurysm or Aortic Arch Aneurysm:
  2. Descending Thoracic Aortic Aneurysm or Abdominal Aortic Aneurysm:
A
  1. Open surgical repair (OSR)

2. Thoracic endovascular aneurysm repair (TEVAR)

35
Q

Complications of Thoracic aortic aneurysm:

  1. Left-sided ____
  2. ____ s/t bleeding into the mediastinum
A
  1. Hemothorax
  2. Cardiac Tamponade

( s/t bleeding into the mediastinum)

36
Q

most important risk factor in Abdominal Aortic Aneurysms

A

Smoking

37
Q

Lower back pain
Pulsatile abdominal mass
Bruit on auscultation
Diagnosis:

A

Abdominal Aortic Aneurysm

Infrarenal Aortic Aneurysm

38
Q

Best initial and confirmatory test for:

  1. Abdominal Aortic Aneurysm
  2. Thoracic Aortic Aneurysm
A
  1. Abdominal ultrasound
    (Unless pt Obese → CTA or MRA)
  2. CXR → CTA chest
39
Q

Indications for repair of Abdominal Aortic Aneurysms:

Diameter: ≥ __ cm
Expansion rate: ≥ _ cm/year
Symptomatic aneurysm
Has ruptured

A
  1. 5

1. 0

40
Q

Indications for repair of Thoracic Aortic Aneurysms

Diameter
AScending aneurysm ≥ __ cm
DEscending aneurysm ≥ __cm

A
  1. 5

6. 5

41
Q

How do you surveillance an un-repaired AAA of
5.0–5.4 cm

[imaging] q [timing]

A

Ultrasound every 6 months

42
Q

Pt presents with Sudden onset of severe, tearing back & abdominal pain with radiation to the flank, buttocks, legs, or groin.
Vitals show tachycardia & 90/40 (narrowed PP)
(Hypovolemic shock)
Painful pulsatile mass on abdominal exam.

Diagnosis?

A

Ruptured AAA

43
Q

Unstable patients with suspected Abdominal aortic aneurysm rupture management:

A

Surgery (ideally within 90 minutes):
EVAR or OSR

(diagnosis is clinical)

44
Q

stable patients with suspected Abdominal aortic aneurysm rupture management:

A

CTA Thorax, Abdomen, and Pelvis
(for surgical planning)

(Black crescent within mural thrombus + extravasation of contrast)

45
Q

1 x Screening for AAA with abdominal U/S

In men aged __ years with any h/o smoking

A

65–75

46
Q 
Risk Factors for Aortic Dissection:
\_\_\_ (most common risk factor)
Trauma ( \_\_\_\_ injury)
Vasculitis (syphilis)
\_\_\_\_ use
[congenital] 
Connective tissue disease (Marfan syndrome, Ehlers-Danlos syndrome)
A

Hypertension

deceleration injury

Amphetamines and cocaine

Bicuspid aortic valve (Turner syndrome)

47
Q

Clinical features:

  • Sudden and severe tearing/ripping pain in anterior chest (ascending) or back (descending)
  • Interscapular or retrosternal pain
  • Hypertension
  • Asymmetrical blood pressure and pulse readings between limbs
  • Syncope, diaphoresis, confusion

Diagnosis

A

Aortic Dissection

48
Q

Normal ___ findings do not rule out aortic dissection.

A

CXR

If clinical suspicion for acute aortic dissection persists, perform a CT C/A/P

49
Q

In STABLE pt with suspected aortic dissection what imaging is best:

A

CTA

chest, abdomen, and pelvis

50
Q

In UN-stable pt with suspected aortic dissection what imaging is best:

(Or if pt has renal insufficiency or contrast allergy)

A

Transesophageal echocardiography (TEE)

CXR if TEE not available

51
Q

Classic CXR finding of aortic dissection:

A

Widened mediastinum

initial test, but is negative get CTA

52
Q

Treatment
Stanford A dissection: ____
Stanford B dissection: ____

A

Ascending = surgical emergency!

Conservative = Anti-hypertensives, Telemetry
unless complications occur

53
Q

In patient with suspected aortic dissection what management do you want to start first then second?

A

FIRST: Beta Blocker (BP control prevents progression)

Second: VASODILATOR
(IV sodium nitroprusside)

*Avoid thrombolytic therapy & Inotropes

Surgery (36 decks)

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