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129 Cards in this Set
- Front
- Back
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What are 3 reasons patients are sent to a vascular lab for abdominal scans?
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1. Atherosclerosis
2. Aneurysms 3. Celiac Axis Compression Syndrome |
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When was the 1st mesenteric ultrasound study performed?
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1984
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When were ultrasound studies widely accepted and for what reason?
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1991, After two extensive reports were published
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What is the most common referral reason for abdominal scans?
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Atherosclerosis
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What 3 signs will a patient with atherosclerosis present with?
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1. Abdominal pain (intestinal angina)
2. Weight Loss 3. Abdominal Bruit |
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How many vessels and which ones must be involved to have significant symptoms?
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2 out of the 3; Celiac, SMA and IMA
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What vessel must be visualized if there is disease found in the celiac or SMA?
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IMA
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What is the definition of mesenteric ischemia?
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Lack of flow to mesentery
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True or False
Mesenteric ischemia is often misdiagnosed due to flow compensation |
True
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What 2 vessels are when stenosed or occluded cause mesenteric ishcemia?
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1. Celiac
2. SMA |
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What is an acute mesenteric ishcemia - Embolization?
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Due to an emoblic event
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True or False
Patients who are under the age of 50 will present with acute mesenteric ischemia |
False
Patients over the age of 50 |
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True or False
Patients will usually have cardiac disease that is associated with valvular and atherosclerotic disease |
True
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How many patients have a history of embolus to an extremity or the brain?
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1/3
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Where is the most common source of the emboli?
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Cardiac
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What are 3 symptoms of Acute - Emoblization?
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1. Sudden onset of abdominal pain
2. Vomiting and Nausea 3. May have blood diarrhea |
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What are 5 symptoms of Acute Thrombosis?
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1. More gradual onset of abdominal pain
2. Weight loss 3. Post-prandial pain 4. Altered bowel habits 5. Intestinal spasm |
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True or False
Chronic - Occlusion is very common and easy to diagnose |
False
Chronic - Occulsion is rare, and difficult to diagnose |
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True or False
Chronic - Occlusion occurs gradually |
True
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What are the 4 extensive collateral compensatory flow channels?
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1. Superior and Inferior Pancreaticoduodenal artery
2. Gastroduodenal artery 3. Arc of Riolan (Meandering mesenteric artery) 4. IMA |
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What are 7 symptoms of chronic - occlusion?
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1. Weight loss (Most Common)
2. Post-prandial pain (usually epigastric) 3. Dull to severe ache 4. Dependent on amount of food 5. Food fear or small meal syndrome 6. Constipation due to lack of food 7. Diarrhea |
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How soon does post-prandial pain occur and how long does it last with patients who have chronic - occlusion?
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Occurs 30 min - 1 hour
Lasts 1-2 hours |
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True or False
Patients with Chronic - Occlusion will have more vascular disease such as; CAD, PAD, CVD |
True
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Where is the most common place a R hepatic artery will originate from?
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Celiac Axis
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Where else besides the celiac axis can the R hepatic artery originate?
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SMA
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What 2 places can the common hepatic artery originate instead of the celiac axis?
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1. SMA
2. Aorta |
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True or False
The celiac axis and the SMA always come of separately from the aorta? |
False
The celiac axis and SMA can come off together from the Aorta |
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True or False
Mesenteric vein thrombosis is not usually the primary cause of ischemia |
True
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What are 5 symptoms of Mesenteric vein thrombosis?
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1. Diffuse abdominal pain (that may become constant)
2.Gradual onset of symptoms 3. Low grade temperature 4. Distended abdomen 5. Abdominal tenderness |
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What are 5 causes of Mesenteric vein thrombosis?
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1. Trauma
2. Malignancy 3. Contraceptives, 4. Coagulation disorders 5. Pregnancy |
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How many types of Mesenteric vein thrombosis are there and what are they?
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Two
1. Primary Mesenteric Vein Thrombosis 2. Secondary Mesenteric Vein Thrombosis |
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What percentage of cases are primary mesenteric vein thrombosis?
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25-50%
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What is the cause of primary mesenteric vein thrombosis?
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Unknown
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What is primary mesenteric vein thrombosis most commonly associated with?
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Intra-abdominal sepsis
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True or False
Primary mesenteric vein thrombosis is more common than secondary mesenteric vein thrombosis |
False
Secondary mesenteric vein thrombosis is more common than primary mesenteric vein thrombosis |
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What are 7 types of differential diagnoses to Mesenteric diseases?
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1. Systemic Lupus
2. Rheumatorid arthritis 3. Radiation, causing arteritis 4. Allergic vasculitis 5. Arteritis following aortic coarctation resection 6. Bowel infarction 7. Celiac Axis Compression Syndrome |
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What is the bowel infarction defined as?
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Death of Bowel
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What is the mortality rate of Bowel infarction?
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50-75% if untreated
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What is the treatment for bowel infarction?
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Bowel resection
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What is celiac axis compression syndrome defined as?
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Extrinsic compression of the celiac trunk with respiration
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What is celiac axis compression syndrome also known as?
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Median arcuate ligament syndrome and
Dunbar syndrome |
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What is the process of the diaphragm during inhalation for a patient with celiac axis compression?
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The diaphragm rises and moves away from celiac axis
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What is the process of the diaphragm during expiration for a patient with celiac axis compression?
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Lowers and crosses the celiac axis, pinching it off
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Who does celiac axis most commonly affect?
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Younger femaies
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What fraction of people have been found to have significant compression of the celiac axis on autopsies?
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1/3
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What are 2 symptoms of celiac axis compression syndrome?
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1. Intermittent abdominal pain
2. Weight loss if severe |
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Where are splenic artery aneurysms most common?
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Distal vessel bifurcaiton
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What is the usual type of a splenic artery aneurysm?
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Saccular
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What percentage of patients have multiple aneurysms?
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20%
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What is the male to female ratio of splenic artery aneurysms?
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4:1 Females
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True or False
Splenic artery aneurysms are usually symptomatic |
False
They are usually asymptomatic |
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What are 3 symptoms of splenic artery aneurysms?
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1. Abdominal pain
2. Bruit 3. No mass |
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What are 7 causes of splenic artery aneurysms?
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1. Arterial fibrodysplasia
2. Portal hypertension with splenomegaly 3. Women with repeated pregnancies (6 or more) 4. Arteriosclerosis 5. Inflammatory processes (Chronic pancreatitis) 6. Blunt Trauma 7. Bacterial infection (I.V. Drug users) |
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What is the mortality rate if a splenic artery aneurysm rupture?
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Greater than 25%
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What is the rupture rate of a splenic artery aneuysm in pregnant women?
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95%
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What is the mortality rate of the pregnant mother if a splenic artery aneurysm is ruptured?
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70%
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What is the mortality rate of the fetus if a splenic artery aneurysm is ruptured?
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95%
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What is the most common type of aneurysm?
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Splenic artery aneurysm
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What is the second most common type of aneurysm?
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Hepatic artery aneurysm
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What is the usual size of a hepatic artery aneurysm?
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Greater than 2cm
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What is the usual shape of a hepatic artery aneurysm that is greater than 2cm?
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Saccular
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What is the usual shape of a hepatic artery aneurysm that is less than 2cm?
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Fusiform
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What percentage of exprahepatic vessels are usually involved with hepatic artery aneurysm?
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80%
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What percentage of hepatic artery aneurysms occur within the liver?
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20%
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What is the male to female ratio?
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2:1 Male
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What is the usual age range for a patient with hepatic artery aneurysms?
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60's
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True or False
Hepatic artery aneurysm is usually asymptomatic |
True
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What are 4 symptoms of hepatic artery aneurysms?
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1. R upper quadrant pain
2. Pain not related to eating 3. Compression of biliary duct 4. No palpable mass, No bruit |
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What are 2 causes of hepatic artery aneurysms?
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1. Bacterial infection - Drug use
2. Medial degeneration of trauma |
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What is the mortality rate of hepatic artery aneurysms?
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More than 35%
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True or False
Jaundice may be present in patients due to biliary duct obstruction |
True
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What is the percentage of celiac artery aneurysms?
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4%
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True or False
Celiac artery aneurysms are very common |
False
Celiac artery aneurysms are rare |
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True or False
Celiac artery aneurysms are usually asymptomatic |
True
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Who is affected more by celiac artery aneurysms male or females?
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Males
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What is the age range of patients who have celiac artery aneurysms?
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40's
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What are 3 symptoms of celiac artery aneurysm?
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1. Abdominal pain
2. Bruit 3. No mass |
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What are 2 causes of celiac artery aneurysm?
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1. Atherosclerosis
2. Medial degeneration |
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True or False
Gastric artery aneurysms are very easy to image with ultrasound |
False
Gastric artery aneurysms are very difficult to image with ultrasound |
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What is the percentage of gastric artery aneurysm?
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4%
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True or False
Gastric artery aneurysms are asymptomatic until they rupture |
True
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True or False
There are no known causes of gastric artery aneurysms |
True
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What is the third most common type of aneurysm?
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Superior mesenteric artery aneurysm
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If the patient is under the age of 50 what is the cause of a superior mesenteric aneurysm?
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Bacterial
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If the patient is over the age of 60 what is the cause of superior mesenteric aneurysm is?
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Other types of causes
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What are 5 causes of secondary mesenteric vein thrombosis?
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1. Portal hypertension
2. Visceral infection/perforated viscus 3. Appendicitis 4. Diverticulitis 5. Pelvic abcess |
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True or False
Both men and women are equally affected by superior mesenteric aneurysms |
True
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What are the 2 symptoms of superior mesenteric aneurysms?
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1. Abdominal pain
2. Palpable mass |
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What are 3 causes of superior mesenteric aneurysms?
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1. Bacterial
2. Atherosclerosis 3. Trauma |
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True or False
Inferior mesenteric artery aneurysm is very rare |
True
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What are 2 types of treatments for aneurysms?
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1. Open Surgery
2. Endovascular repair |
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True or False
Duplex can be used for surveillance purposes |
True
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What are 7 causes of mesenteric artery dissection?
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1. Atherosclerosis
2. Fibromuscular dysplasia 3. Mycotic infection 4. Trauma 5. Connective tissue disorders 6. Vasculitis 7. Iatrogenic-induced dissections |
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Where is the most common mesenteric artery dissections located?
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SMA; associated with aortic dissection
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What are the 2 treatments of mesenteric artery dissection and what are they dependent upon?
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1. Conservative management with anticoagulation
2. Aggressive approach with endovascular stent or surgical procedure Depends on degree of intestinal ischemia |
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How should a patient be prepped for a duplex exam?
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NPO for 12 hours for morning appt.
Take meds with H20 if needed |
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True or False
A patient history and physical assessment should be performed |
True
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What type of frequency probe should be used for an abdominal scan?
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Low frequency
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What angle should be used when assessing vessels?
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60 degrees or less
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What regions of the vessels should readings be taken from?
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Proximal, mid and distal
More if needed |
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How will a stent appear on b-mode imaging?
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Echogenic and light up walls of lumen
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What should be used when identifying a dissection during a duplex exam?
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Color Doppler
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What will help to eliminate bowel sounds and wall motion during a duplex exam?
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Lowing the filter
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What should be adjusted for color usage to limit aliasing to reliably determine flow direction?
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PRF
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What does color usage help with?
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Tortuous vessels
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True or False
Reduced pressure in celiac leads SMA collaterals to divert blood to liver and spleen via gastroduodenal artery |
True
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To what vessel does the gastroduodenal artery back fill too?
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Common hepatic artery
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What is retrograde flow in common hepatic artery predictive of?
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A 100% of celiac axis significant stenosis or occlusion
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What are 7 Mesenteric scanning pitfalls?
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1. Tortuous vessels will mimic stenotic waveforms
2. Misdiagnosis due to collateral flow 3. Bowel motion 4. Respiratory motion 5. Body habitus 6. Pt. condition 7. Angles |
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What are 4 interventions used for Acute ischemia?
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1. Embolectomy
2. Thrombectomy 3. Bypass 4. Bowel resection |
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What is the intervention for chronic ischemia?
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Aortomesenteric bypass
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What is the intervention of celiac compression?
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Median arcuate ligament cut
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What are 3 interventions of mesenteric vein thrombosis?
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1. Bowel resection
2. Anticoagulation 3. Shunt if portal vein is involved |
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What is the normal fasting waveform of the celiac trunk?
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Low resistance due to continuous antegrade flow through systole and diastole
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What 2 organs does the celiac trunk supply blood too?
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1. Liver
2. Spleen |
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What is the stenotic waveform of the celiac trunk?
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Localized with greater velocity
Post-stenotic turbulence with blunted waveform |
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What is the post-prandial waveform of the celiac trunk?
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Responds to food later than the SMA
Peaks greater in flow 40 min after eating High resistance flow |
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What is the occlusive waveform of the celiac trunk?
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No flow detected
Reversal of flow in collaterals SMA compensates |
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What is the normal fasting waveform of the SMA?
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High resistance signal
Diastolic flow reversal at times (not all the time) |
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What is the stenotic waveform of the SMA?
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Loss of reversal component
Increased velocities and post stenotic turbulence |
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What is the post-prandial waveform of the SMA?
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Increase in PSV 2x and EDV 3x
Reduction or loss of reversal flow component Maximum flow will chang 30-60 min post food |
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What is the occlusive waveform of the SMA?
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No flow detected
Reversal in collaterals (Gastroduodenal a.) Celiac artery compensates |
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What is the normal fasting waveforms of the IMA?
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High resistance signal
Flow reversal No response to food (usually) |
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What is the stenotic waveform of the IMA?
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Increased PSV and EDV
Loss of reversal flow component Turbulence |
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What is the post-prandial waveform of the IMA?
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Normally no response, because it supplies the colon
Response if collaterals supply |
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What is the occlusive waveform of the IMA?
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No flow detected
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What are the normal waveforms of the hepatic and splenic arteries?
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Low resistance, continuous diastolic flow
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What are the stenotic waveforms of the hepatic and splenic arteries?
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Increased PSV and EDV
Turbulence Dampened flow distally |
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What are the occlusive waveforms of the hepatic and splenic arteris?
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No flow detected
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