Mesenteric ischemia physical examination

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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 distention 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, feculent ordor to the breath is present, peritoneal signs develop and bowel sounds become absent. 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:

• Tachycardia with irregular pulse in case of atrial fibrillation
• Tachypnea
• Weak/bounding pulse

Skin

• Pallor

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 stages of ischemia when transmural infarction has occured:

• Abdominal distention
• Generalized Abdominal tenderness
• Rebound tenderness
• Guarding may be present

Extremities

• Cyanosis
• Pitting/non-pitting edema of the upper/lower extremities