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  #1  
Old 11-10-2012
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Question best initial test q for acute mesenteric ischemia

is it CT scan or angio ?
[patient is stable but in grave pain, high LDH,TLC]

* for chronic mesenteric ischemia, it is CT scan
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  #2  
Old 11-10-2012
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If its acute you go straight to the OR, without waiting for studies to come.

If I had to choose between the 2 ill pick CT angio
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Angiography

If severe (lactic acidosis, high amylase, high LDH) ---> fluid resuscitation followed by Exploratory Laparotomy.

CT scan if diagnosis in not certain to rule out other conditions like Acute Pancreatitis althogh the CT may show bowel wall thickening/ edema ("thumbprinting") and air within the bowel wall (pneumatosis intestinalis).
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Old 11-30-2012
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Default mesenteric ischemia

A 63-year-old man has had midabdominal colicky pain, with nausea, anorexia, and vomiting for the past 48 hours. The patient has a history of deep venous thrombosis and had a pulmonary embolus in the distant past, but he is not currently on anticoagulants. His temperature is 37 C (98.6 F), blood pressure is 95/60 mm Hg, and pulse is 102/min. On physical examination he has a distended and tympanitic abdomen, but does not have an "acute abdomen." Abdominal x-rays show multiple distended loops of small bowel and distension of the right colon, up to the middle of the transverse colon. Stool is positive for occult blood what would be the next step
and the answer is CT scan of abdomen

please can any one explain this presentation..i got confused due to colicky nature of pain and air fluid levels and thought its an obstruction
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Old 11-30-2012
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Quote:
Originally Posted by doc s.j View Post
A 63-year-old man has had midabdominal colicky pain, with nausea, anorexia, and vomiting for the past 48 hours. The patient has a history of deep venous thrombosis and had a pulmonary embolus in the distant past, but he is not currently on anticoagulants. His temperature is 37 C (98.6 F), blood pressure is 95/60 mm Hg, and pulse is 102/min. On physical examination he has a distended and tympanitic abdomen, but does not have an "acute abdomen." Abdominal x-rays show multiple distended loops of small bowel and distension of the right colon, up to the middle of the transverse colon. Stool is positive for occult blood what would be the next step
and the answer is CT scan of abdomen

please can any one explain this presentation..i got confused due to colicky nature of pain and air fluid levels and thought its an obstruction
Looks like the old dude has colon cancer causing the obstruction- evident from stool positive for occult blood. Colicky nature of the pain is cuz of the obstruction and air fluid level cuz nothing is going out.
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Quote:
Originally Posted by callmerocky2 View Post
Looks like the old dude has colon cancer causing the obstruction- evident from stool positive for occult blood. Colicky nature of the pain is cuz of the obstruction and air fluid level cuz nothing is going out.
diagnosis is mesenteric ischemia
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diagnosis is mesenteric ischemia
Are u sure?? Agreed he has DVT and PE making him high risk for acute mesenteric ischemia but it says he does not have signs of acute abdomen, i thought when got mesenteric ischemia u have severe acute pain :/
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Originally Posted by callmerocky2 View Post
Are u sure?? Agreed he has DVT and PE making him high risk for acute mesenteric ischemia but it says he does not have signs of acute abdomen, i thought when got mesenteric ischemia u have severe acute pain :/
yes the question is from kaplan bank.. this is confusing, the pain should be generalized type and constant in mesenteric ischemia???why colicky here...somebody please explain this vignette
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Originally Posted by doc s.j View Post
A 63-year-old man has had midabdominal colicky pain, with nausea, anorexia, and vomiting for the past 48 hours. The patient has a history of deep venous thrombosis and had a pulmonary embolus in the distant past, but he is not currently on anticoagulants. His temperature is 37 C (98.6 F), blood pressure is 95/60 mm Hg, and pulse is 102/min. On physical examination he has a distended and tympanitic abdomen, but does not have an "acute abdomen." Abdominal x-rays show multiple distended loops of small bowel and distension of the right colon, up to the middle of the transverse colon. Stool is positive for occult blood what would be the next step
and the answer is CT scan of abdomen

please can any one explain this presentation..i got confused due to colicky nature of pain and air fluid levels and thought its an obstruction

its most likely colonic obstruction due to cancer, hence CT best initial test

accrdng to me if its mesenteric ischemia, there would be hematochezia not occult blood, continuous pain out of proportion to physical findings.

Here there is a confusing picture(even if u consider mesenteric ischemia) hence proceed with CT which would clear the scenario.....
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Originally Posted by doc s.j View Post
yes the question is from kaplan bank.. this is confusing, the pain should be generalized type and constant in mesenteric ischemia???why colicky here...somebody please explain this vignette

it may be atypical presentation of M.Ischemia....so proceed with CT( as said above by Novobiocin)
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Originally Posted by anomali View Post
it may be atypical presentation of M.Ischemia....so proceed with CT( as said above by Novobiocin)

other options are: colonoscopy, doppler ultrasound ,exp lap ,laroscopy and upper gi endoscopy..i chosed colonoscopy..i got your point, it might be an atypical presentation of mesenteric ischemia..if its colon CA then i think coloscopy would have been the correct option.
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