The hallmark of the diagnosis of acute mesenteric ischaemia is abrupt onset of intense cramping epigastric and periumbilical pain out of proportion to the findings on abdominal examination.
Diarrhea
Vomiting
Bloating
Melena
Clinical Presentation
Classical Triad: Acute severe abdominal pain, no abdominal signs, rapid hypovolemic.
FBC - may show decreased haemoglobin due to plasma loss and increase in WCC
Amylase -elevated
ABG - metabolic acidosis
Abdominal X-ray - early may show gasless bowels.
CT/MRI
Remember: Severe abdominal pain with metabolic acidosis is bowel ischemia until proven otherwise
Aetiology
Aetiology Acute mesenteric ischemia can result from occlusion of a mesenteric vessel arising from an embolus, which may emanate from an atheroma of the aorta or cardiac mural thrombus, or from primary thrombosis of a mesenteric vessel, usually at a site of atherosclerotic stenosis. Embolic occlusion is more common in the superior mesenteric artery than the celiac or inferior mesenteric artery, presumably because of the less acute angle of the superior mesenteric artery off the abdominal aorta.
Remember: AF with abdominal pain think mesenteric ischaemia
Chronic Mesenteric Ischaemia
References
UptoDate
Best Practice
Oxford Handbook Clinical Surgery
Oxford Handbook Clinical Medicine