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  #1  
Old 09-22-2014
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Default mesenteric ischemia vs ischemic colitis

3.A 74-year-old woman presents complaining of very severe abdominal pain, which began abruptly 8 hours ago. She describes the pain as "the worst I've ever had." On questioning, she is unable to give a precise location but indicates that her entire mid-abdomen is extremely painful. She has been followed for the past 10 years for symptoms of congestive heart failure after she had an anterior wall myocardial infarction. She has remained relatively well controlled with only occasional dyspnea on exertion. Her medications include captopril, furosemide, digoxin, isosorbide dinitrate, and aspirin. She has not had any prior surgery. On physical examination, she appears extremely uncomfortable.
Her temperature is 38.9 C (101.9 F), blood pressure is 174/102 mm Hg, and pulse is 118/min and irregularly irregular. On cardiac examination, there is a regular heart rhythm with a II/VI holosystolic murmur heard best at the apex and radiating to the axilla. She has an irregularly irregular S1 and S2, and scattered bibasilar rales.
An abdominal examination reveals mild distention and no hepatosplenomegaly. The abdomen is diffusely soft but very tender to palpation. A rectal examination reveals brown, guaiac-positive stool. She has no audible bowel sounds. Which of the following is the most likely diagnosis?

a) Diverticulitis
b)Ischemic colitis
c) Mesenteric ischemia
d)Pancreatitis
e)Small bowel obstruction
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  #2  
Old 09-22-2014
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Is it C

the only difference i can remember is Mesenteric Ischemia is caused because of an Emboli (M-E) and is seen in Pts with cardiac problems etc

Ischemic Colitis - due to decreased blood to mesentery so seen after Pt has eaten cause increased blood is required to digest food so exacerbation of condition and pain.

Correct me if im wrong.thanks.
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Old 09-22-2014
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Quote:
Originally Posted by samren17 View Post
Is it C

the only difference i can remember is Mesenteric Ischemia is caused because of an Emboli (M-E) and is seen in Pts with cardiac problems etc ==> This is correct. But the explanation below is also a characteristic of mesenteric ischemia. It can be caused by emboli or by atherosclerosis.

If atherosclerosis then you will see intestinal angina, ie abdominal pain after every meal which will make the patient avpid eating and lose considerable amount of weight.

Mesenteric Ischemia caused by emboli would be abrupt onset in pt w emboli risks such as in the patient above.


Ischemic Colitis - due to decreased blood to mesentery so seen after Pt has eaten cause increased blood is required to digest food so exacerbation of condition and pain.

Correct me if im wrong.thanks.
Ischemic colitis usually due to decreased blood flow, especially in the splenic flexure area (eg dehydration). Sx usually present w/ abdominal pain + bloody and loose stool.
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  #4  
Old 09-23-2014
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Originally Posted by samren17 View Post
Is it C

the only difference i can remember is Mesenteric Ischemia is caused because of an Emboli (M-E) and is seen in Pts with cardiac problems etc

Ischemic Colitis - due to decreased blood to mesentery so seen after Pt has eaten cause increased blood is required to digest food so exacerbation of condition and pain.

Correct me if im wrong.thanks.
Hey, I thought mesenteric ischemia was when the pt eats and then there is pain.
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  #5  
Old 09-23-2014
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so whats the answer to the question?
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Old 09-23-2014
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so whats the answer to the question?
It's mesenteric ischemia
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Old 09-23-2014
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Originally Posted by doc007 View Post
Hey, I thought mesenteric ischemia was when the pt eats and then there is pain.
Yep. That is a sign of chronic mesenteric ischemia caused by atherosclerosis. You will see that the patient has lots of atherosclerosis risk factors. DM, HTN, PAD, CAD, etc. Good luck doc 007
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  #8  
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Yep. That is a sign of chronic mesenteric ischemia caused by atherosclerosis. You will see that the patient has lots of atherosclerosis risk factors. DM, HTN, PAD, CAD, etc. Good luck doc 007
So, only the absence of bloody diarrhea makes this mesenteric ischemia? Is that the only way to differentiate between the two?
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Old 09-23-2014
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So, only the absence of bloody diarrhea makes this mesenteric ischemia? Is that the only way to differentiate between the two?
you can also see the Hx which risk factors do the patient present with. CAD risks are more likely for mes ischemia. This particular pt has afib, a strong risk for emboli.

dec in blood flow (eg decomp CHF, prolonged shock, dehydration) accompanied w abd pain and bloody diarrhea, will point to ischemic colitis.
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  #10  
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Quote:
Originally Posted by IMlover View Post
you can also see the Hx which risk factors do the patient present with. CAD risks are more likely for mes ischemia. This particular pt has afib, a strong risk for emboli.

dec in blood flow (eg decomp CHF, prolonged shock, dehydration) accompanied w abd pain and bloody diarrhea, will point to ischemic colitis.
Ok, Thank you so much!
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  #11  
Old 09-23-2014
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Ok, Thank you so much!
you're very welcome! best of luck!
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