Mesenteric ischemia diagnostic study of choice
|
Mesenteric ischemia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Mesenteric ischemia diagnostic study of choice On the Web |
|
American Roentgen Ray Society Images of Mesenteric ischemia diagnostic study of choice |
|
Risk calculators and risk factors for Mesenteric ischemia diagnostic study of choice |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
The defintive diagnosis of mesenteric ischemia relies mainly on the imaging studies of which the most accurate is high resolution computed tomographic angiography. It demonstrates the site of occluion in the vessels as well as helps determine the choice of treatment opted.
Diagnostic Study of Choice
Gold standard/Study of choice:
- High resolution computed tomographic angiography is the gold standard test for the diagnosis of mesenteric ischemia for the following reasons:
- Determines the type of occlusion
- Identifies collateral circulation
- Potential sources of inflow
- Cirrhosis is primarily a histological diagnosis. Liver biopsy is the gold standard test for the diagnosis of cirrhosis.
- The following result of liver biopsy is confirmatory of cirrhosis:
- Presence of bridging fibrous septa
- Parenchymal nodules bearing a mixture of replicating and sensecent hepatocytes
- Involvement of most or all of the liver
- Liver biopsy should be performed in order to:
- Confirm the diagnosis
- Determine prognosis
- Diagnose the underlying etiology of cirrhosis
- Alcoholic liver disease : Liver biopsy may show hepatocyte necrosis, presence of mallory bodies, neutrophilic infiltration and perivenular inflammation
- Primary biliary cirrhosis : Gold standard diagnostic modality is the detection of antimitochondrial antibodies along with liver biopsy as confirmation if florid bile duct lesions
- Manage and evaluate rejection subsequent to liver transplantation
- Evaluate abnormal hepatic investigations
- Rule out hepatic neoplasms
- Diagnose cholestatic liver disease
- Evaluate infiltrative or granulomatous disease
- Evaluate unexplained jaundice
- Evaluate drug reactions
- Monitor progression of diseases such as primary biliary cirrhosis, chronic hepatitis C or alcoholic liver disease
- Cirrhosis is mainly diagnosed based on clinical presentation, laboratory, and radiologic data.
Sensitivity and specificity:[1]
| Do | Sensitivity | Specificity |
|---|---|---|
| High resolution computed tomographic angiography | 94% | 95% |
✔= The best test based on the feature
Diagnostic results
The following result of computed tomographic angiography is confirmatory of mesenteric ischemia:
| Findings | ||
|---|---|---|
| Classic meniscus sign |
|
|
| Multiple areas of narrowing and irregularity |
|
|
Sequence of Diagnostic Studies
The [name of investigation] should be performed when:
- The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
- A positive [test] is detected in the patient, to confirm the diagnosis.
Diagnostic Criteria
- Here you should describe the details of the diagnostic criteria.
- Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
- Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
- Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
- Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
- To view an example (endocarditis diagnostic criteria), click here
- If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
- You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
- [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
- There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
- [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
IF there are clear, established diagnostic criteria:
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
- The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:
- There are no established criteria for the diagnosis of [disease name].
References
- ↑ 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.