Vascular 2 Flashcards
Gangrenous Ischemic colitis
severe acute ischemia of the large bowel resulting in ___
infarction
Nongangrenous Ischemic colitis
hypoperfusion of the large bowel
Management?
Conservative
Mostly transient and self-limiting
Acute mesenteric ischemia
acute inadequate blood flow to the ___ bowel (arterial or venous) that can result in bowel infarction
small
Chronic mesenteric ischemia
constant OR episodic hypoperfusion of the small intestine, usually due to
atherosclerosis
Causes of Ischemic colitis:
- Thromboembolism (a-fib, IE)
- Hypovolemia (dehydration, hemorrhage)
- Vasoconstrictive drugs
4.
Cardiovascular surgery (Aortic repairs & cardiac bypass)
Sites at High risk for compromise in Ischemic colitis (2)
because they are “watershed areas”
Splenic flexure
Rectosigmoid junction
Clinical features of Ischemic colitis:
- Hyperactive phase
- Sudden onset of ___ abdominal pain
- ____ stools - Shock phase (rare)
- _____
Crampy
Loose, Bloody
Peritonitis
(rebound/guarding)
In severe ischemic colitis labs can show:
↑ ___, ___, Creatinine Kinase
Leukocytosis
Lactate
LDH
Imaging for suspected Ischemic colitis
First line:
Confirmatory:
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
Mild-Moderate Ischemic colitis
- No specific laboratory finding
- Procedure of choice in moderate cases =
Colonoscopy ( edema, cyanosis, +/- ulceration)
Management of mild-moderate sxs:
Conservative:
IVF, NPO, +/- NGT
Antiplatelet +/- Anticoagulation therapy
Definitive management of Ischemic colitis with signs of sepsis and peritoneal irritation?
Ex-lap
postprandial mismatch between splanchnic blood flow and intestinal metabolic demand → postprandial pain
Diagnosis:
Chronic Mesenteric Ischemia
Clinical features Crampy abdominal/intestinal angina Recurrent, dull, postprandial epigastric pain ~within the first hour after eating a fear of eating → weight loss Diagnosis:
Chronic Mesenteric Ischemia
Chronic Mesenteric Ischemia
Imaging:
Treatment:
CT-Angiography
Frequent, small low-fat meals Revascularization surgery (if severe)
Acute Mesenteric Ischemia typically caused by what
Atrial Fibrillation → arterial embolism
SMA (∼ 90% of cases)
A patient with ____ typically presents with severe abdominal pain (usually periumbilical) fever, +/-bloody diarrhea, leukocytosis, ↑ Lactate.
Typically h/o a-fib
Acute Mesenteric Ischemia
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.
Acute arterial thrombosis
confirmatory test for Acute Mesenteric Ischemia
CT-Angiography
- wall thickening
- distended bowel with black flecks and stripes aka Pneumatosis Intestinalis (suggests transmural ischemia or infarction)
Treatment of Acute Mesenteric Ischemia
1. Bowel rest +
Definitive management:
- hemodynamically unstable: ___
- hemodynamically stable patients w/o signs of advanced ischemia: ___
Long-term measures:
Statin therapy
____ therapy
IVFs, NGT, NPO + ABxs
- Ex-Lap for (unstable, peritonitic, or septic)
- Embolectomy mechanically
- Bypass of artery - Endovascular revascularization (stable)
- Angioplasty + Stenting
- Catheter-based Heparin (thrombolytics) or mechanical thrombectomy
Anticoagulation (for long-term)
Bilaterally absent femoral, popliteal, and ankle pulses
Pain in both legs and the buttocks
Erectile dysfunction
Leriche syndrome (aortoiliac occlusive disease)
Leriche syndrome (aortoiliac occlusive disease) sxs (3)
bilateral absent LE pulses
pain in legs/butt
erectile dysfunction