Unit II : Celiac and Mesenteric Arteries

Vessels visualized in the mesenteric arteries exam.

Abdominal Aorta, Celiac Axis, Superior Mesenteric Artery, Inferior Mesenteric Artery

Celiac is the ___ major branch off of the Aorta

1st

SMA is just ____ to the celiac axis and runs _____ to the abdominal aorta in long axis.

Distal; Parallel

The celiac axis consists of which vessels?

Splenic artery, common hepatic artery, and left gastric artery

What does the common hepatic artery branch into?

R and L hepatic artery, gastroduodenal artery, and left gastric artery

What does the celiac and SMA supply blood to?

stomach, duodenum, small bowel, liver, pancreas, and spleen

What does the SMA and IMA supple blood to?

Colon, and proximal rectum

When will you see symptoms of ischemia?

When there is compromise of at least 2 of the 3 mesenteric vessels

What resistance is the celiac artery?

low

What doppler is used for evaluating the celiac artery?

pulsed wave

What is the flow pattern of the celiac artery?

low resistant; high end diastolic velocity

Why is the celiac artery low resistant?

To satisfy the organs need for continuous forward flow within both systole and diastole

Is the celiac artery flow pattern dependent on food intake?

No

When is the SMA/IMA high resistant?

When fasting

When is the SMA/IMA low resistant?

When the pt. has eaten

When fasting, what does the pw doppler look like in the SMA/IMA?

high resistance; low end diastolic velocities

Why is the resistance high in the SMA/IMA when fasting?

due to vasoconstriction

Post - prandial - _______ blood flow needed for digestion.

increase

What does the flow pattern look like in the SMA/IMA post-prandial?

low resistant; PSV and PEDV increases

What causes increased blood flow post-prandial?

vasodilation

What is the purpose of mesenteric doppler exams?

evaluating for insufficiency of flow to intestines

What is mesenteric ischemia?

significant decrease of blood flow to small intestine and colon due to blockage of mesenteric arteries

Why is mesenteric ischemia uncommon?

due to extensive collateral circulation

What is mesenteric ischemia usually caused by?

atherosclerosis / occlusive disease at origins of vessels

What is the pancreaticoduodenal arcade?

network of vessels surrounding pancreas and duodenum and permits collateral flow between celiac, SMA, and IMA

What does the GDA connect?

celiac and SMA

What is the Arc of Riolan / Marginal artery of dummond?

connects SMA to IMA

__% or greater stenosis in at least __ of the 3 mesenteric arteries is required for a pt. to have symptoms of ischemia.

70; 2

What test will they run to make sure of mesenteric ischemia?

CT scan

What is Acute ischemia caused by?

embolus, thrombus, or external compression of the vessel

What will the pt. present with when they have acute ischemia?

sudden onset of abdominal pain, distension, fever, dehydration, acidosis

What will the pt. present with when they have chronic ischemia?

post-prandial abdominal cramps/pain, abdominal bruit, diarrhea, bloating, change in bowel habits, weight loss, “fear of food” syndrome

What should be considered in elderly pt, with unexplained abdominal pain and weight loss?

chronic ischemia

Chronic ischemia is seen in patients with…

HTN, high cholesterol, smokers, CAD, PVD

What is the pt. prep for mesenteric exam?

fasting to begin and then 30 minutes post-prandial

What drops can you give to patients 15 minutes prior to and exam?

simethecone

Elevated velocities in post-prandial states can be confused with _____

stenosis