The EM Educator Series: Mesenteric Ischemia

Author: Alex Koyfman, MD (@EMHighAK) // Reviewed by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!


Case 1:

A 63-year-old female with a history of atrial fibrillation presents with abdominal pain that began suddenly. She also has had severe nausea with several episodes of non-blood vomiting and diarrhea. She is tachycardic but afebrile. She does not have tenderness on abdominal exam, but she is writhing in pain.

 

Case 2:

A 75-year-old male is hypotensive and in severe heart failure. He is on norepinephrine and epinephrine. On your reevaluation, he has worsening abdominal pain and diarrhea.

 

Case 3:

A 30-year-old female presents with abdominal pain. This is her fourth visit in 3 weeks. She has experienced intermittent abdominal pain and nausea for these last 3 weeks. She is on oral contraceptives.

 

Considerations:

  • What are the four types of mesenteric ischemia?
  • What are the major risk factors for mesenteric ischemia?
  • How can this disease present, and how does it relate to the pathophysiology of each type?
  • What are pitfalls with laboratory evaluation?
  • What imaging is recommended, and what are pitfalls?
  • What is the ED management?
  • What specialists should be consulted?

 

Suggested Resources:

 

 

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