• No embolic or thrombotic cause of vascular obstruction
• Associated low flow state (sepsis, cardiac dysrhythmia)
• Severe, diffuse abdominal pain
• Gross or occult intestinal bleeding
• Minimal physical findings
• In about 25% of patients with intestinal ischemia, vascular occlusion does not involve a major artery or vein (although arterial stenosis is usually present)
• In the presence of some other acute disease such as a cardiac dysrhythmia or sepsis, splanchnic vasoconstriction occurs, and the intestine becomes ischemic because of low perfusion pressure and flow
• Serum amylase is elevated
• Significant base deficits
• Increased serum phosphate
• Increased serum lactate
• Abdominal x-ray
• Specific findings occur late: Intramural gas and gas in the portal venous system
• GI contrast radiography: May reveal "thumbprinting" and disordered motility
• CT scan
-Diffuse distention with air-fluid levels
-Intestinal wall thickening
-Intramural gas and gas in the portal venous system
• Arteriography: Documents the absence of major vascular occlusion but is not otherwise diagnostic in most cases
• The diagnosis is suspected when acute abdominal pain develops in a potentially susceptible patient
• Ischemia is most pronounced on the antimesenteric border, and the mucosa may be extensively involved before abnormalities are visible on the serosal surface
• Serum electrolytes
• Serum amylase
• Serum lactate
• ABG measurements
• Abdominal x-ray
• CT scan
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