Mesenteric ischemia laboratory findings: Difference between revisions

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==Overview==
==Overview==
No specific biomarker for the diagnosis of mesenteric ischemia has been identified to date. However, certain biomarkers are released into circulation as a result of ischemic injury to the intestine, which can be detected in the blood.
No specific biomarker for the diagnosis of [[Mesenteric ischemia|mesenteric]] ischemia has been identified to date. However, certain biomarkers are released into circulation as a result of [[Ischemia|ischemic]] injury to the [[intestine]], which can be detected in the [[blood]].


==Laboratory Findings==
==Laboratory Findings==
The commonly seen laboratory findings in mesenteric ischemia include:<ref name="pmid6333551">{{cite journal| author=Graeber GM, Cafferty PJ, Wolf RE, Harmon JW| title=An analysis of creatine phosphokinase in the mucosa and the muscularis of the gastrointestinal tract. | journal=J Surg Res | year= 1984 | volume= 37 | issue= 5 | pages= 376-82 | pmid=6333551 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6333551  }} </ref><ref name="pmid19279473">{{cite journal| author=Mensink PB, Hol L, Borghuis-Koertshuis N, Geelkerken RH, Huisman AB, Doelman CJ et al.| title=Transient postprandial ischemia is associated with increased intestinal fatty acid binding protein in patients with chronic gastrointestinal ischemia. | journal=Eur J Gastroenterol Hepatol | year= 2009 | volume= 21 | issue= 3 | pages= 278-82 | pmid=19279473 | doi=10.1097/MEG.0b013e32832183a7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19279473  }} </ref>
The commonly seen laboratory findings in [[Mesenteric ischemia|mesenteric]] ischemia include:<ref name="pmid6333551">{{cite journal| author=Graeber GM, Cafferty PJ, Wolf RE, Harmon JW| title=An analysis of creatine phosphokinase in the mucosa and the muscularis of the gastrointestinal tract. | journal=J Surg Res | year= 1984 | volume= 37 | issue= 5 | pages= 376-82 | pmid=6333551 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6333551  }} </ref><ref name="pmid19279473">{{cite journal| author=Mensink PB, Hol L, Borghuis-Koertshuis N, Geelkerken RH, Huisman AB, Doelman CJ et al.| title=Transient postprandial ischemia is associated with increased intestinal fatty acid binding protein in patients with chronic gastrointestinal ischemia. | journal=Eur J Gastroenterol Hepatol | year= 2009 | volume= 21 | issue= 3 | pages= 278-82 | pmid=19279473 | doi=10.1097/MEG.0b013e32832183a7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19279473 }} </ref><ref name="pmid24402763">{{cite journal| author=Matsumoto S, Sekine K, Funaoka H, Yamazaki M, Shimizu M, Hayashida K et al.| title=Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia. | journal=Br J Surg | year= 2014 | volume= 101 | issue= 3 | pages= 232-8 | pmid=24402763 | doi=10.1002/bjs.9331 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24402763 }} </ref>


{| class="wikitable"
{| class="wikitable"
Line 22: Line 22:
|Less sensitive
|Less sensitive
| rowspan="5" |
| rowspan="5" |
* Hyperphosphatemia
* [[Hyperphosphatemia]]
* Hyperkalemia
* [[Hyperkalemia]]
* High procalcitonin levels
* High [[procalcitonin]] levels
| rowspan="5" |D-dimer
| rowspan="5" |High
[[D-dimer]]
| rowspan="5" |
| rowspan="5" |
* I-FABP
* I-[[FABP1|FABP]]
* Serum alpha glutathione S-transferase
* Serum alpha glutathione S-transferase
* Cobalt albumin binding assay
* [[Cobalt]] [[albumin]] binding assay
|-
|-
|Leukocytosis with predominance of immature white blood cells
|[[Leukocytosis]] with predominance of immature white blood cells
| rowspan="4" |High levels of  
| rowspan="4" |High levels of  
* Serum amylase
* Serum [[amylase]]
* Aspartate aminotransferase
* [[Aspartate]] [[Aminotransferases|aminotransferase]]
* Lactate dehydrogenase  
* Lactate [[dehydrogenase]]
* Creatine phosphokinase  
* [[Creatine phosphokinase]]
|-
|-
|Increased hematocrit
|Increased [[hematocrit]]
|-
|-
|High anion gap metabolic acidosis
|High anion gap [[metabolic acidosis]]
|-
|-
|Lactic acidosis
|[[Lactic acidosis]]
|}
|}
'''Early findings:'''
'''Early findings:'''
Line 48: Line 49:
'''(More sensitive)'''<ref name="pmid24238311">{{cite journal| author=Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC| title=The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. | journal=Acad Emerg Med | year= 2013 | volume= 20 | issue= 11 | pages= 1087-100 | pmid=24238311 | doi=10.1111/acem.12254 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24238311  }} </ref><ref name="pmid7948358">{{cite journal| author=Lange H, Jäckel R| title=Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. | journal=Eur J Surg | year= 1994 | volume= 160 | issue= 6-7 | pages= 381-4 | pmid=7948358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7948358  }} </ref><ref name="pmid15043738">{{cite journal| author=Glenister KM, Corke CF| title=Infarcted intestine: a diagnostic void. | journal=ANZ J Surg | year= 2004 | volume= 74 | issue= 4 | pages= 260-5 | pmid=15043738 | doi=10.1111/j.1445-2197.2004.02956.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043738  }} </ref><ref name="pmid21842126">{{cite journal| author=Zhang FX, Ma BB, Liang GZ, Zhang H| title=Analysis of serum enzyme levels in a rabbit model of acute mesenteric ischemia. | journal=Mol Med Rep | year= 2011 | volume= 4 | issue= 6 | pages= 1095-9 | pmid=21842126 | doi=10.3892/mmr.2011.553 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21842126  }} </ref><ref name="pmid: 25844063">{{cite journal| author=van der Voort PH, Westra B, Wester JP, Bosman RJ, van Stijn I, Haagen IA et al.| title=Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia. | journal=BMC Anesthesiol | year= 2014 | volume= 14 | issue=  | pages= 111 | pmid=: 25844063 | doi=10.1186/1471-2253-14-111 | pmc=4384375 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25844063  }} </ref><ref name="pmid22699523">{{cite journal| author=Demir IE, Ceyhan GO, Friess H| title=Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia?. | journal=Dig Surg | year= 2012 | volume= 29 | issue= 3 | pages= 226-35 | pmid=22699523 | doi=10.1159/000338086 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22699523  }} </ref><ref name="DemirCeyhan2012">{{cite journal|last1=Demir|first1=Ihsan Ekin|last2=Ceyhan|first2=Güralp O.|last3=Friess|first3=Helmut|title=Beyond Lactate: Is There a Role for Serum Lactate Measurement in Diagnosing Acute Mesenteric Ischemia|journal=Digestive Surgery|volume=29|issue=3|year=2012|pages=226–235|issn=1421-9883|doi=10.1159/000338086}}</ref><ref name="pmid19424744">{{cite journal| author=Evennett NJ, Petrov MS, Mittal A, Windsor JA| title=Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. | journal=World J Surg | year= 2009 | volume= 33 | issue= 7 | pages= 1374-83 | pmid=19424744 | doi=10.1007/s00268-009-0074-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19424744  }} </ref><ref name="pmid28691670">{{cite journal| author=Salamone G, Raspanti C, Licari L, Falco N, Rotolo G, Augello G et al.| title=Non-Occlusive Mesenteric Ischemia (NOMI) in Parkinson's disease: case report. | journal=G Chir | year= 2017 | volume= 38 | issue= 2 | pages= 71-76 | pmid=28691670 | doi= | pmc=5509387 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28691670  }} </ref>
'''(More sensitive)'''<ref name="pmid24238311">{{cite journal| author=Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC| title=The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. | journal=Acad Emerg Med | year= 2013 | volume= 20 | issue= 11 | pages= 1087-100 | pmid=24238311 | doi=10.1111/acem.12254 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24238311  }} </ref><ref name="pmid7948358">{{cite journal| author=Lange H, Jäckel R| title=Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. | journal=Eur J Surg | year= 1994 | volume= 160 | issue= 6-7 | pages= 381-4 | pmid=7948358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7948358  }} </ref><ref name="pmid15043738">{{cite journal| author=Glenister KM, Corke CF| title=Infarcted intestine: a diagnostic void. | journal=ANZ J Surg | year= 2004 | volume= 74 | issue= 4 | pages= 260-5 | pmid=15043738 | doi=10.1111/j.1445-2197.2004.02956.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043738  }} </ref><ref name="pmid21842126">{{cite journal| author=Zhang FX, Ma BB, Liang GZ, Zhang H| title=Analysis of serum enzyme levels in a rabbit model of acute mesenteric ischemia. | journal=Mol Med Rep | year= 2011 | volume= 4 | issue= 6 | pages= 1095-9 | pmid=21842126 | doi=10.3892/mmr.2011.553 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21842126  }} </ref><ref name="pmid: 25844063">{{cite journal| author=van der Voort PH, Westra B, Wester JP, Bosman RJ, van Stijn I, Haagen IA et al.| title=Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia. | journal=BMC Anesthesiol | year= 2014 | volume= 14 | issue=  | pages= 111 | pmid=: 25844063 | doi=10.1186/1471-2253-14-111 | pmc=4384375 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25844063  }} </ref><ref name="pmid22699523">{{cite journal| author=Demir IE, Ceyhan GO, Friess H| title=Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia?. | journal=Dig Surg | year= 2012 | volume= 29 | issue= 3 | pages= 226-35 | pmid=22699523 | doi=10.1159/000338086 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22699523  }} </ref><ref name="DemirCeyhan2012">{{cite journal|last1=Demir|first1=Ihsan Ekin|last2=Ceyhan|first2=Güralp O.|last3=Friess|first3=Helmut|title=Beyond Lactate: Is There a Role for Serum Lactate Measurement in Diagnosing Acute Mesenteric Ischemia|journal=Digestive Surgery|volume=29|issue=3|year=2012|pages=226–235|issn=1421-9883|doi=10.1159/000338086}}</ref><ref name="pmid19424744">{{cite journal| author=Evennett NJ, Petrov MS, Mittal A, Windsor JA| title=Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. | journal=World J Surg | year= 2009 | volume= 33 | issue= 7 | pages= 1374-83 | pmid=19424744 | doi=10.1007/s00268-009-0074-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19424744  }} </ref><ref name="pmid28691670">{{cite journal| author=Salamone G, Raspanti C, Licari L, Falco N, Rotolo G, Augello G et al.| title=Non-Occlusive Mesenteric Ischemia (NOMI) in Parkinson's disease: case report. | journal=G Chir | year= 2017 | volume= 38 | issue= 2 | pages= 71-76 | pmid=28691670 | doi= | pmc=5509387 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28691670  }} </ref>


* Leukocytosis with predominance of immature white blood cells
* [[Leukocytosis]] with predominance of immature white blood cells
* Increased hematocrit
* Increased [[hematocrit]]
* High anion gap metabolic acidosis
* High anion gap [[Metabolic acidosis|metabolic]] acidosis
* Lactic acidosis (I-lactate) 86% sensitivity and 44% sensitivity  
* [[Lactic acidosis|Lactic]] acidosis (I-lactate) 86% sensitivity and 44% sensitivity  
* High phosphate levels (80% sensitivity)  
* High [[phosphate]] levels (80% sensitivity)  
'''(Less sensitive)'''<ref name="pmid: 7305484">{{cite journal| author=Graeber GM, Wukich DK, Cafferty PJ, O'Neill JF, Wolf RE, Ackerman NB et al.| title=Changes in peripheral serum creatine phosphokinase (CPK) and lactic dehydrogenase (LDH) in acute experimental colonic infarction. | journal=Ann Surg | year= 1981 | volume= 194 | issue= 6 | pages= 708-15 | pmid=: 7305484 | doi= | pmc=1345383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7305484  }} </ref><ref name="pmid7212812">{{cite journal| author=Graeber GM, Cafferty PJ, Reardon MJ, Curley CP, Ackerman NB, Harmon JW| title=Changes in serum total creatine phosphokinase (CPK) and its isoenzymes caused by experimental ligation of the superior mesenteric artery. | journal=Ann Surg | year= 1981 | volume= 193 | issue= 4 | pages= 499-505 | pmid=7212812 | doi= | pmc=1345104 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7212812  }} </ref><ref name="pmid15043738">{{cite journal| author=Glenister KM, Corke CF| title=Infarcted intestine: a diagnostic void. | journal=ANZ J Surg | year= 2004 | volume= 74 | issue= 4 | pages= 260-5 | pmid=15043738 | doi=10.1111/j.1445-2197.2004.02956.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043738  }} </ref><ref name="pmid6738045">{{cite journal| author=Graeber GM, Wolf RE, Harmon JW| title=Serum creatine kinase and alkaline phosphatase in experimental small bowel infarction. | journal=J Surg Res | year= 1984 | volume= 37 | issue= 1 | pages= 25-32 | pmid=6738045 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6738045  }} </ref><ref name="pmid2418904">{{cite journal| author=Wilson C, Imrie CW| title=Amylase and gut infarction. | journal=Br J Surg | year= 1986 | volume= 73 | issue= 3 | pages= 219-21 | pmid=2418904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2418904  }} </ref><ref name="pmid7082974">{{cite journal| author=Jamieson WG, Marchuk S, Rowsom J, Durand D| title=The early diagnosis of massive acute intestinal ischaemia. | journal=Br J Surg | year= 1982 | volume= 69 Suppl | issue=  | pages= S52-3 | pmid=7082974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7082974  }} </ref>
'''(Less sensitive)'''<ref name="pmid: 7305484">{{cite journal| author=Graeber GM, Wukich DK, Cafferty PJ, O'Neill JF, Wolf RE, Ackerman NB et al.| title=Changes in peripheral serum creatine phosphokinase (CPK) and lactic dehydrogenase (LDH) in acute experimental colonic infarction. | journal=Ann Surg | year= 1981 | volume= 194 | issue= 6 | pages= 708-15 | pmid=: 7305484 | doi= | pmc=1345383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7305484  }} </ref><ref name="pmid7212812">{{cite journal| author=Graeber GM, Cafferty PJ, Reardon MJ, Curley CP, Ackerman NB, Harmon JW| title=Changes in serum total creatine phosphokinase (CPK) and its isoenzymes caused by experimental ligation of the superior mesenteric artery. | journal=Ann Surg | year= 1981 | volume= 193 | issue= 4 | pages= 499-505 | pmid=7212812 | doi= | pmc=1345104 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7212812  }} </ref><ref name="pmid15043738">{{cite journal| author=Glenister KM, Corke CF| title=Infarcted intestine: a diagnostic void. | journal=ANZ J Surg | year= 2004 | volume= 74 | issue= 4 | pages= 260-5 | pmid=15043738 | doi=10.1111/j.1445-2197.2004.02956.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043738  }} </ref><ref name="pmid6738045">{{cite journal| author=Graeber GM, Wolf RE, Harmon JW| title=Serum creatine kinase and alkaline phosphatase in experimental small bowel infarction. | journal=J Surg Res | year= 1984 | volume= 37 | issue= 1 | pages= 25-32 | pmid=6738045 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6738045  }} </ref><ref name="pmid2418904">{{cite journal| author=Wilson C, Imrie CW| title=Amylase and gut infarction. | journal=Br J Surg | year= 1986 | volume= 73 | issue= 3 | pages= 219-21 | pmid=2418904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2418904  }} </ref><ref name="pmid7082974">{{cite journal| author=Jamieson WG, Marchuk S, Rowsom J, Durand D| title=The early diagnosis of massive acute intestinal ischaemia. | journal=Br J Surg | year= 1982 | volume= 69 Suppl | issue=  | pages= S52-3 | pmid=7082974 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7082974  }} </ref>


High levels of  
High levels of  
* Serum amylase (50% sensitivity)
* Serum [[amylase]] (50% sensitivity)


* Aspartate aminotransferase
* [[Aspartate]] [[Aminotransferases|aminotransferase]]
* Lactate dehydrogenase  
* [[Lactate dehydrogenase|Lactate]] [[dehydrogenase]]
* Creatine phosphokinase  
* [[Creatine phosphokinase]]
Abnormality in the lab findings is mostly seen after the infarction of the bowel has ensued. However, any patient with unrecognized abdominal pain and high anion gap metabolic acidosis should be ruled out for mesenteric ischemia.
Abnormality in the lab findings is mostly seen after the [[infarction]] of the bowel has ensued. However, any patient with unrecognized [[Abdominal pain|abdominal]] pain and high anion gap [[Metabolic acidosis|metabolic]] acidosis should be ruled out for [[Mesenteric ischemia|mesenteric]] ischemia.


'''Late findings:'''<ref name="pmid: 26185718">{{cite journal| author=Karaca Y, Gündüz A, Türkmen S, Menteşe A, Türedi S, Eryiğit U et al.| title=Diagnostic Value of Procalcitonin Levels in Acute Mesenteric Ischemia. | journal=Balkan Med J | year= 2015 | volume= 32 | issue= 3 | pages= 291-5 | pmid=: 26185718 | doi=10.5152/balkanmedj.2015.15661 | pmc=4497696 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26185718  }} </ref>
'''Late findings:'''<ref name="pmid: 26185718">{{cite journal| author=Karaca Y, Gündüz A, Türkmen S, Menteşe A, Türedi S, Eryiğit U et al.| title=Diagnostic Value of Procalcitonin Levels in Acute Mesenteric Ischemia. | journal=Balkan Med J | year= 2015 | volume= 32 | issue= 3 | pages= 291-5 | pmid=: 26185718 | doi=10.5152/balkanmedj.2015.15661 | pmc=4497696 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26185718  }} </ref>
* Hyperphosphatemia
* [[Hyperphosphatemia]]
* Hyperkalemia
* [[Hyperkalemia]]
* High procalcitonin levels
* High [[procalcitonin]] levels


==References==
==References==
Line 73: Line 74:


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Latest revision as of 19:12, 15 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

No specific biomarker for the diagnosis of mesenteric ischemia has been identified to date. However, certain biomarkers are released into circulation as a result of ischemic injury to the intestine, which can be detected in the blood.

Laboratory Findings

The commonly seen laboratory findings in mesenteric ischemia include:[1][2][3]

Laboratory findings
Early findings Late findings Other tests Experimental tests
More sensitive Less sensitive High

D-dimer

Leukocytosis with predominance of immature white blood cells High levels of
Increased hematocrit
High anion gap metabolic acidosis
Lactic acidosis

Early findings:

(More sensitive)[4][5][6][7][8][9][10][11][12]

(Less sensitive)[13][14][6][15][16][17]

High levels of

Abnormality in the lab findings is mostly seen after the infarction of the bowel has ensued. However, any patient with unrecognized abdominal pain and high anion gap metabolic acidosis should be ruled out for mesenteric ischemia.

Late findings:[18]

References

  1. ↑ Graeber GM, Cafferty PJ, Wolf RE, Harmon JW (1984). "An analysis of creatine phosphokinase in the mucosa and the muscularis of the gastrointestinal tract". J Surg Res. 37 (5): 376–82. PMID 6333551.
  2. ↑ Mensink PB, Hol L, Borghuis-Koertshuis N, Geelkerken RH, Huisman AB, Doelman CJ; et al. (2009). "Transient postprandial ischemia is associated with increased intestinal fatty acid binding protein in patients with chronic gastrointestinal ischemia". Eur J Gastroenterol Hepatol. 21 (3): 278–82. doi:10.1097/MEG.0b013e32832183a7. PMID 19279473.
  3. ↑ Matsumoto S, Sekine K, Funaoka H, Yamazaki M, Shimizu M, Hayashida K; et al. (2014). "Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia". Br J Surg. 101 (3): 232–8. doi:10.1002/bjs.9331. PMID 24402763.
  4. ↑ Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC (2013). "The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis". Acad Emerg Med. 20 (11): 1087–100. doi:10.1111/acem.12254. PMID 24238311.
  5. ↑ Lange H, Jäckel R (1994). "Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease". Eur J Surg. 160 (6–7): 381–4. PMID 7948358.
  6. ↑ 6.0 6.1 Glenister KM, Corke CF (2004). "Infarcted intestine: a diagnostic void". ANZ J Surg. 74 (4): 260–5. doi:10.1111/j.1445-2197.2004.02956.x. PMID 15043738.
  7. ↑ Zhang FX, Ma BB, Liang GZ, Zhang H (2011). "Analysis of serum enzyme levels in a rabbit model of acute mesenteric ischemia". Mol Med Rep. 4 (6): 1095–9. doi:10.3892/mmr.2011.553. PMID 21842126.
  8. ↑ van der Voort PH, Westra B, Wester JP, Bosman RJ, van Stijn I, Haagen IA; et al. (2014). "Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia". BMC Anesthesiol. 14: 111. doi:10.1186/1471-2253-14-111. PMC 4384375. PMID 25844063 : 25844063 Check |pmid= value (help).
  9. ↑ Demir IE, Ceyhan GO, Friess H (2012). "Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia?". Dig Surg. 29 (3): 226–35. doi:10.1159/000338086. PMID 22699523.
  10. ↑ Demir, Ihsan Ekin; Ceyhan, Güralp O.; Friess, Helmut (2012). "Beyond Lactate: Is There a Role for Serum Lactate Measurement in Diagnosing Acute Mesenteric Ischemia". Digestive Surgery. 29 (3): 226–235. doi:10.1159/000338086. ISSN 1421-9883.
  11. ↑ Evennett NJ, Petrov MS, Mittal A, Windsor JA (2009). "Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia". World J Surg. 33 (7): 1374–83. doi:10.1007/s00268-009-0074-7. PMID 19424744.
  12. ↑ Salamone G, Raspanti C, Licari L, Falco N, Rotolo G, Augello G; et al. (2017). "Non-Occlusive Mesenteric Ischemia (NOMI) in Parkinson's disease: case report". G Chir. 38 (2): 71–76. PMC 5509387. PMID 28691670.
  13. ↑ Graeber GM, Wukich DK, Cafferty PJ, O'Neill JF, Wolf RE, Ackerman NB; et al. (1981). "Changes in peripheral serum creatine phosphokinase (CPK) and lactic dehydrogenase (LDH) in acute experimental colonic infarction". Ann Surg. 194 (6): 708–15. PMC 1345383. PMID 7305484 : 7305484 Check |pmid= value (help).
  14. ↑ Graeber GM, Cafferty PJ, Reardon MJ, Curley CP, Ackerman NB, Harmon JW (1981). "Changes in serum total creatine phosphokinase (CPK) and its isoenzymes caused by experimental ligation of the superior mesenteric artery". Ann Surg. 193 (4): 499–505. PMC 1345104. PMID 7212812.
  15. ↑ Graeber GM, Wolf RE, Harmon JW (1984). "Serum creatine kinase and alkaline phosphatase in experimental small bowel infarction". J Surg Res. 37 (1): 25–32. PMID 6738045.
  16. ↑ Wilson C, Imrie CW (1986). "Amylase and gut infarction". Br J Surg. 73 (3): 219–21. PMID 2418904.
  17. ↑ Jamieson WG, Marchuk S, Rowsom J, Durand D (1982). "The early diagnosis of massive acute intestinal ischaemia". Br J Surg. 69 Suppl: S52–3. PMID 7082974.
  18. ↑ Karaca Y, Gündüz A, Türkmen S, Menteşe A, Türedi S, Eryiğit U; et al. (2015). "Diagnostic Value of Procalcitonin Levels in Acute Mesenteric Ischemia". Balkan Med J. 32 (3): 291–5. doi:10.5152/balkanmedj.2015.15661. PMC 4497696. PMID 26185718 : 26185718 Check |pmid= value (help).
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