Vascular Diseases Of The Abdomen Flashcards
Dieulafoy lesions
A large arterial tear in the sub mucosal layer of the gastric wall
-it can erode and cause hemorrhages in the GI tract
Through the to be caused by HTN in the larger vessels which causes these small vessels to get larger and possibly rupture
- the most common area for this is the gastric cardia along the lesser curvature
Clinical features = vomiting blood or blood in stool without any other symptoms
**this is pretty rare also
“Watermelon stomach” vs hemorrhagic gastritis
Both are the same thing except they are technically called different things and have different appearances
Hemorrhagic gastritis = severe portal HTN gastropathy with cobble stone appearance anywhere in the GI tract
Watermelon stomach = gastric antral vascular ectasia with a longitudinal vascular appearance
** hemorrhagic gastritis responds to BBs and “TIPS” but vascular actasia usually requires thermoablative therapy
What are the most common causes of pancreatitis?
Gallstones or severe alcoholism
What is Angiodysplasia?
Cherry red spots throughout the body that is a depiction of arterovenous malformations
- often produce spontaneous hemorrhages and bleeding within the GI tract
- often associated with increased age and straining patterns
very heavily linked to heyde syndrome (Aortic valve stenosis with angiodysplasia bleeding due to spontaneous vWF proteolysis through the aortic valve stenosis
Treatment is cauterization
What is Heyde syndrome?
Syndrome of GI bleeding from multiple Angiodysplasia’s caused by aortic stenosis.
- caused by pathogenic vWF factors which bind to aortic valve and form platelet plugs
Symptoms:
- bloody vomiting and very dark stool
- **has aortic stenosis valve
treatment is replacement of valve and surgical resection of bleeding
When does a AAA need surgery?
If it is growing 1/2 a cm per 6 months
Or
If it is larger than 5cm at any point
Aortocaval fistula
An abnormal connection between aortic and vena cava
- almost always only occurs in chronic abdominal aortic aneurysms
Symptoms:
- hepatic failure
- severe back pain
- renal insufficiency
- serious bilateral lower limb edema
- hematuria and hematachezia
- **always appears blue from the belly button down, but normal from above belly button
Treatment = abdominal aorta placed pressure clips
Median arcuate ligament syndrome
A very rare occurrence which results in the median arcuate ligament compressing the celiac trunk
Symptoms:
- severe ab pain and mesenteric ischemia that is no explained by other means (often is NOT seen on imaging)
Requires surgery to remove part of the median arcuate ligament
Splenic artery aneurysm
Is most common aneurysm seen in pregnancy (2nd most overall with #1 being AAA)
Causes the spleen to fail and necrosis
(SMA syndrome)
When the SMA artery compresses the transverse dueodenum
- almost exclusively seen in anorexia nervosa patients if seen at all
causes build up of food in the proximal duodenum and stomach
Always shows mass vomiting/bloating and ab pain and extreme weight loss
Treatment = nasal jejunum tube to feed the patient. DONT JUST GIVE FOOD. Feeding the patient slowly causes fat to form around the duodenum and lift the SMA off it. Too fast and they will just vomiting it up
Nutcracker syndrome
Similar to SMA syndrome except this time the SMA constricts the left renal vein
produces severe left sided ab pain that radiates to the back, nausea/vomiting and varicocele in the left testicle (in males only)
Treatment = remove left renal vein and Anastomosis onto the inferior vena cava somewhere else
Where are the two watershed areas of the colon?
Splenic flexure (superior and inferior mesenteric artery area)
Sigmoid colon (inferiorly mesenteric and hypogastric artery area)
both are exceptionally susceptible to ischemic events in the IMA/V
Protein C/Protein S deficiency
Causes increased clotting spontaneous throughout the body = ischemic events
Who is Lester dragstedt?
American surgeon who was the first to successfully separate conjoined twins
**Also was the first to pioneer truncal vagotomy as a surgical procedure
What is a billroth 2 gastrojejunostomy
Operation where partial gastrectomy is performed.
- the antrum and pyloris of the stomach is removed and then attached to jejunum. Duodenum is sewn shut
*different from billroth 1 where billroth 1 reattaches to the duodenum
Indications are tumors and severe PUD in distal stomach
Theodore billroth
Farther of modern GI surgeries
- first to remove a section of esophagus And also excision of a larynx successfully
Mesenteric venous thrombosis
Most exclusively seen in patients with portal hypertension secondary liver cirrhosis and disease
- also commonly alcoholics
Caused due to stats in the mesenteric venous system, NOT because of Hypercoagulability states
Treatment:
- anticoagulation drugs
- laparoscopy
- bowel resection if needed
what is angioplasty?
Surgical procedure to restore blood flow through arteries
- thread a thin tube through a blood vessel in the arm/groin to the artery and blow a tiny balloon up
What is antrectomy?
Surgical procedure to remove the antrum of the stomach
Indications:
- PUD in the duodenum
- gastric ulcers in the antrum
- benign gastric tumors
Contraindications:
- cirrhosis of the liver
- extensive scarring of the duodenum
Cullen’s sign
Superifical brushing red edema marks around the umbilicus
- signals retroperitoneal bleeding (usually pancreatitis, aortic ruptures, or ruptured ectopic pregnancies
Grey turners sign
Brushing edema between last rib and iliac crest
- signals retroperitoneal bleeding (usually pancreatitis, aortic ruptures, or ruptured ectopic pregnancies
TIPS procedure
Indications:
- any need to reduce portal HTN
- variceal bleeding (active or past)
- ascites present
Procedure
- small wire-mesh coil is placed into any liver vein
- also uses angioplasty to bypass the common portal vein and lower the pressure in the portal system
What kind of scenarios would one expect to see protein C/S and/or antithrombin deficiencies?
Liver diseases:
- shows C/S and antithrombin deficiency
Warfarin therapy:
- protein C and S deficiency
Pregnancy and inflammatory diseases
- protein S deficiency
Heparin therapy
- antithrombin deficiency
Acute thrombosis:
- protien S and antithrombin deficiency
