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25 Cards in this Set
- Front
- Back
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1. The 66-year-old woman carotid and femoral artery bruits presents with the signs and symptoms consistent with mesenteric angina leading to “food fear” and massive weight loss. Diagnosis?
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a. Postprandial abdominal pain
b. Massive weight loss c. Signs of advanced atherosclerotic changes suggestive of possible Chronic Mesenteric Ischemia |
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2. Best treatment for above scenario?
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a. Aortomesenteric bypass grafting.
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3. Hallmarks of Chronic Mesenteric Ischemia?
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a. Food fear with postprandial pain
b. Significant weight loss |
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4. Excellent screening test for mesenteric ischemia has centres with high quality vascular laboratories?
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a. Duplex ultrasonography.
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5. How does a duplex ultrasonography diagnose chronic mesenteric ischemia?
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a. A normal study performed both before and after a food challenge accurately rule out proximal mesenteric artery vascular disease.
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6. We can give accurate assessment of the superior mesenteric and celiac artery origins?
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a. Magnetic resonance angiography
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7. Gold standard for definitive diagnosis and therapy planning of chronic mesenteric ischemia?
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a. Selective arteriography with lateral aortic projections.
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8. Best treatment for chronic mesenteric ischemia?
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a. Operative revascularization
b. Definitive revascularization with antegrade aortomesenteric bypass or perivisceral aortic endarterectomy best option. c. In selected high-risk patients, angioplasty can be a useful treatment |
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9. Most common cause of chronic mesenteric ischemia?
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a. Atherosclerotic occlusive disease of the mesenteric arteries
b. Typically a patient has occlusion of 2 of the 3 vessels, with significant disease in the remaining mesenteric vessels. |
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10. Acute mesenteric ischemia?
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a. A surgical emergency
b. Can be caused by acute embolus in the SMA or the coeliac arteries. c. There is usually no history of chronic symptoms |
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11. What test can aid in diagnosis of acute mesenteric ischemia but may lead to treatment delay?
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a. Arteriography. Thus, clinical judgment should be exercised in deciding whether imaging should be performed prior to emergent laparotomy.
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12. Appearance of acute mesenteric ischemia with laparotomy?
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a. Can range from frankly necrotic (elite presentation) to dusty and non-motile.
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13. Arteries supplied by celiac artery?
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1. Hepatic
2. Splenic 3. Left gastric |
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14. What is supplied by superior mesenteric artery?
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a. Small bowel
b. Sending in transverse colon |
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15. What is supplied by superior mesenteric artery?
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a. Distal colon.
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16. Why is the proximal jejuna spared with an embolus?
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a. Because of small proximal collaterals.
b. The embolus tends to lodge in the more distal SMA. |
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17. 2nd look laparotomy?
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a. A 2nd look laparotomy should be strongly considered if the resultant bowel does not appear perfectly viable.
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18. What is the most important postoperative treatment for a 66-year-old man was admitted to the coronary care unit because of new onset atrial fibrillation. After 24 hours, he develops the acute onset of abdominal pain and distension, and on examination is found to have diffuse peritonitis. The patient undergoes exploratory laparotomy with resection in necrotic bowel?
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a. Systemic heparinization.
b. This patient likely has a mural thrombus of the left atrium, which has embolized to be superior mesenteric artery, leading to bowel necrosis. c. Initiation of IV heparin is important to stabilize and prevent further extension of the clot. |
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19. Ligation of the IMA during aortic aneurysm repair is most likely to produce ischaemia to which segment of the intestine?
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a. Splenic flexure of colon- this is the watershed area.
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20. What does the watershed area of the colon include?
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a. The splenic flexure and distal sigmoid colon/upper rectum
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21. A 69-year-old woman with cardiogenic shock following an anterior wall MI develops diffuse abdominal pain. On PE she is noted to have BP 85/50 mm Hg, pulse 90 bpm, nontender abdomen, cool extremities, with skin mottling in the lower extremities. What is the best management approach at this time?
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a. Dobutamine drip
b. The patient described appears to have a systemic low flow state related to poor left ventricular output, resulting in inadequate mesenteric and lower extremity blood flow. c. The patient's physical exam does not suggest Frank necrosis of the ballot this point, therefore exploratory laparotomy is not indicated and could result in a fatal insult. |
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22. Note: a patient with chronic mesenteric ischemia almost always has significant unexplained weight loss. If there is no weight loss, the diagnosis should be questioned.
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22. Note: a patient with chronic mesenteric ischemia almost always has significant unexplained weight loss. If there is no weight loss, the diagnosis should be questioned.
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23. Note: abdominal bruit is a very nonspecific finding. It does not pay to be dogmatic about presence or absence.
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23. Note: abdominal bruit is a very nonspecific finding. It does not pay to be dogmatic about presence or absence.
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24. How is exposure of the SMA for embolectomy accomplished?
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a. Via the root of the small bowel mesentery.
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25. Complete
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25. Complete
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