Scenario 4.3 Mesenteric Ischemia

ECG

Chest X-ray

Abdominal X-ray

Abdominal CT Slice

STUDY: Abdomen/Pelvis CT FINDINGS: CT obtained with limited contrast. Shows mild dilation of small and large bowel with mild to moderate fluid air levels present on several cuts. Thickening in the bowel wall noted and appears to be air inside the mesenteric vessels and the bowel wall itself in the territory of the superior mesenteric artery. No free air or significant free fluid is seen. No other abnormality seen. IMPRESSION: Apparent ileus with likely pneumotosis intestinalis – clinical correlation is recommended.

CBC WBC /mm 3 HGB g/dL HCT % PLT /mm 3

BMP Glucose mg/dL BUN mg/dL Sodium meq/L Potassium meq/L Chloride meq/L CO meq/L Creatinine mg/dL

Cardiac Enzymes Troponin<0.001<0.05 ng/mL CK IU/L CKMB ng/mL

Coagulation Panel PT s INR PTT s

Urinalysis Clarityclear Coloryellow Glucosenegativenegative mg/dL Bilirubinnegative Ketonesnegativenegative mg/dL Sp. grav Bloodnegative pH Proteinnegativenegative mg/dL Urobilinogen EU/dL Nitritesnegative Leukocytesnegative

Urine microscopy Urine RBCNone seenNS/HPF Urine WBCNS/HPF Urine epithelial cells NS/HPF Urine bacteriaNone seen/HPF Urine castsNone seenNS/LPF

Hepatic Function Panel AST U/L ALT U/L Alk. phos U/L T. Bili mg/dL Albumin g/dL GGT U/L

Lipase U/L

Lactate mmol/L