Mesenteric ischemia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination of patients with [[Mesenteric ischemia|mesenteric]] ischemia can be normal in early stages or there may be mild [[Abdominal distension|abdominal]] | Physical examination of patients with [[Mesenteric ischemia|mesenteric]] ischemia can be normal in early stages or there may be mild [[Abdominal distension|abdominal]] [[distension]] in the absence of [[peritonitis]] which presents as [[rebound tenderness]] and [[Abdominal guarding|guarding]]. As the [[ischemia]] progresses to involve all the layers of the intestine (transmural [[infarction]]), abdomen becomes [[Abdominal distension|distended]], [[Peritoneum|peritoneal]] signs develop and [[bowel sounds]] become absent. A feculent odor of the breath may also be noticed. Signs of [[dehydration]] and [[shock]] may also appear if not treated in time. | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating). | *Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to [[sitophobia]] (fear of eating). | ||
===Vital Signs=== | ===Vital Signs=== | ||
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*[[Tachycardia]] with irregular pulse in case of atrial fibrillation | *[[Tachycardia]] with irregular pulse in case of atrial fibrillation | ||
*Tachypnea | *Tachypnea | ||
===Skin=== | ===Skin=== | ||
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===Abdomen=== | ===Abdomen=== | ||
Abdominal examination shows the following findings in later | Abdominal examination shows the following findings in later stages of ischemia when transmural infarction has occured:<ref name="CudnikDarbha2013">{{cite journal|last1=Cudnik|first1=Michael T.|last2=Darbha|first2=Subrahmanyam|last3=Jones|first3=Janice|last4=Macedo|first4=Julian|last5=Stockton|first5=Sherrill W.|last6=Hiestand|first6=Brian C.|last7=Jones|first7=Alan E.|title=The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis|journal=Academic Emergency Medicine|volume=20|issue=11|year=2013|pages=1087–1100|issn=10696563|doi=10.1111/acem.12254}}</ref> | ||
*[[Abdominal distention]] | *[[Abdominal distention]] | ||
*Generalized [[Abdominal tenderness]] | *Generalized [[Abdominal tenderness]] | ||
Revision as of 21:27, 14 January 2018
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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
Physical examination of patients with mesenteric ischemia can be normal in early stages or there may be mild abdominal distension in the absence of peritonitis which presents as rebound tenderness and guarding. As the ischemia progresses to involve all the layers of the intestine (transmural infarction), abdomen becomes distended, peritoneal signs develop and bowel sounds become absent. A feculent odor of the breath may also be noticed. Signs of dehydration and shock may also appear if not treated in time.
Appearance of the Patient
- Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating).
Vital Signs
The following findings are present if the patient presents in a state of shock or hemodyanamic instability:[1]
- Tachycardia with irregular pulse in case of atrial fibrillation
- Tachypnea
Skin
Neck
- Jugular venous distension in case of congestive heart failure.
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope in patients having atherosclerosis.
Heart
- S1 is loud if the patient presents in shock
- S2
- S3 can be present in case of congestibe heart failure.
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
Abdomen
Abdominal examination shows the following findings in later stages of ischemia when transmural infarction has occured:[2]
- Abdominal distention
- Generalized Abdominal tenderness
- Rebound tenderness
- Guarding may be present
Extremities
References
- ↑ Carver, Thomas W.; Vora, Ravi S.; Taneja, Amit (2016). "Mesenteric Ischemia". Critical Care Clinics. 32 (2): 155–171. doi:10.1016/j.ccc.2015.11.001. ISSN 0749-0704.
- ↑ Cudnik, Michael T.; Darbha, Subrahmanyam; Jones, Janice; Macedo, Julian; Stockton, Sherrill W.; Hiestand, Brian C.; Jones, Alan E. (2013). "The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis". Academic Emergency Medicine. 20 (11): 1087–1100. doi:10.1111/acem.12254. ISSN 1069-6563.