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Gastro > Vascular GI Diseases (Tombazzi and Nichols) > Flashcards

Vascular GI Diseases (Tombazzi and Nichols) Flashcards

1
Q

The main arteries involved in GI vascular support include

A

celiac trunk, superior mesenteric artery and inferior mesenteric artery

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2
Q

What is the most sensitive artery to ischemic events

A

SMA

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3
Q

Superior mesenteric is responsible of giving the vascular support to

A

pancreatico-duodenal area
small intestine
right colon

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4
Q

the SMA terminates as the

A

ileo-colic artery

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5
Q

provides protection from ischemia in setting of segmental vascular occlusion

A

collateral circualtion

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6
Q

accounts for a wide fluctuation in splanchnic blood flow

A

Changes in the resistance of mesenteric arterioles

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7
Q

hormones that cause vasoconstriction of GI arterioles

A

catecholamines
Ang II
vasopressin
**secreted during shock and heart failure

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8
Q

hormones that cause vasodialtion of GI arterioles

A

gastrin
CCK
secretin
**secreted after mealtime

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9
Q

describe the intracellular signal responsible for vasodilation

A

production of NO

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10
Q

describe the intracellular signal responsible for vasoconstriction

A

activation of PLC –> IP3 –> release of Ca from SR

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11
Q

most sensitive part of the GI tract/will die first

A

top of the villi

**as ischemia persists, necrosis will progress down towards/thru the wall

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12
Q

How much of the bowel wall must be infarcted for you to clinically see rebound tenderness

A

to the serosa = transmural

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13
Q

clinically how does a mucosal infarct present?

A

bleeding

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14
Q

How much of the wall must be infarted to clinicallt see ileus?

A

villi/mucosa must be gone = mural or transmural

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15
Q

Causes of acute ishemia involving small bowel

A
  1. embolism from L side of heart to SMA
  2. thrombosis of SMA
  3. non-occusive ischemia (HF or shock)
  4. Mesentreric venous thrombosis (hypercoag state–think autoimmune dz)
  5. neoplasm or vasculitis
    * *Goljian
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16
Q

radiographic findings seen with small bowel infarction

A

thumbprinting = due to edema in lamina propria
bowel distension with air fluid level
**Goljian

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17
Q

Common pathogenesis and presentation of ischemic colitis

A

Pathogen: artherlosclerosis of SMA
Presents: pain and tenderness (at splenic flexure commonly) ,hematochezia

**Diffuse disease of small vessels (diabetes mellitus, vasculitis) can also lead to this

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18
Q

Outcome of ischemic colitis

A

generally benign, but fibrosis can lead to strictures and obstruction

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19
Q

What part of the GI tract does ischemic colitis typically invovle

A

watershed/splenic flexure and rectosigmoid area

rarely rectum

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20
Q

Presentation of acute mesenteric ischemia

A

early: abdominal pain, NO ileum
later: rebound tenderness and ileus
* *there is NOT always blood

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21
Q

What does portal vein gas indicate?

A

air from lumen of GI is getting into venous system (??? i think thats what he said??) or bacteria colonizing venous system is producing gas

22
Q

term used to describe dead bowel

A

dusky

23
Q

pseudomembrane and mucin depletion is assc with acute or chonic bowel ischemia

A

acute

24
Q

hyalinization and withering of crypts is assc with acute or chonic bowel ischemia

A

chronic

25
Q

gangrenous necrosis, pneumatosis intestinalis and segmental absence of muscularis propria

A

Neonatal necrotizing enterocolitis (NEC)

26
Q

How is ischemic colitis distinguished from acute mesenteric ischemia

A

IC: > 60 yo, not an acute cuase, mild pain and tenderness, bleeding

AMI: any age, usually acute, severe pain, tenderness appears late, uncommonly assc with bleeding

27
Q

Hallmark presentation of chronic bowel ishemia

A

abdominal pain after eating –> weight loss

** 2 of the 3 splanchnic arteries usually have significant occlusive disease

28
Q

most common cause of chronic ischemia

A

artherlosclerosis

29
Q

time course to presentation of venous mesenteric ischemia relative to arterial

A

venous takes longer–several days

30
Q

upper vs. lower GI bleed is distinguished as being above or below …

A

the ligament of Treitz

**attaches jejunum/duodenum to diaphragm

31
Q

upper or lower acute GI bleed is more common

A

upper

32
Q

epidemiology of acute upper GI bleed

A

men and the elderly

33
Q

T or F: most acute upper GI bleeding requires intervention

A

F: 80% are self limiting

34
Q

causes of acute upper GI bleed

A 
Peptic ulcers
Gastritis and duodenitis
Tumors
Vascular malformation
Esophagitis
Varices
Other
35
Q

Endoscopy can predict the risk of re-bleeding in duodenal ulcers. what finding on endoscopy is assc with the greatest risk of re-bleeding? lowest?

A

active bleeding

white ulcers

36
Q

duodenal ulcers located ___ are most likely to bleed and rebleed

A

high on lesser curvature of stomach (how is this a duodenal ulcer, but whatevs?) and inferior wall of the duodenal bulb

37
Q

are gastric or duodenal ulcers more likely to bleed

A

duodenal

38
Q

esophageal varcies are often secondary to

A

portal HTN and cirrhosis

**Predictive factors fro bleeding include size and grade of liver dysfunction

39
Q

treatment for esophageal varices

A

endoscopic banding

40
Q

Gastric varices may occur as a result of …

A

plenic vein thrombosis resulting from pancreatitis or pancreatic malignancy

41
Q

caused by forceful gastric mucosa prolapse with retching

A

Mallory-Weiss Tear

42
Q

Treatment of Mallory Weiss Tear

A

80-90% spontaneously resolve so only need to stabilize patient

43
Q

What infections can cause upper GI bleed

A

CMV and Herpes

44
Q

What is the most common cases of acute lower GI bleeding

A

diverticulosis and angiodysplasia

45
Q

What is the most common cases of chronic lower GI bleeding

A

hemorrhoids and neoplasia

46
Q

What causes the bleeding in diverticulosis

A

results from penetration of a colonic artery into the dome of a diverticula

47
Q

What is angiodysplasia?

A

degenerative change in blood vessels (become tortuous and dilated) then then bleed

48
Q

Where in the GI tract does angiodysplasia typically occur?

A

cecum and right colon

**usually multiple of them at once

49
Q

angiodysplasia can be secondary to…

A

advanced age, chronic renal failure, prior radiation (if in rectum), watermelon stomach, osler-weber-rendu

50
Q

what are hemorrhoids

A

a real pain in the ass!! badadum…

Variceal dilations of anal and perianal venous plexus

51
Q

hemorrhoids develop secondary to

A

persistent elevated venous pressure

constipation, pregnancy

52
Q

What is the difference between external and internal hemorroids?

A

External hemorrhoids:
from inferior rectal vein, below pectinate line, PAINFUL

Internal hemorrhoids:
superior rectal vein, above pectinate line, PAINLESS

Gastro (25 decks)

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