1. Scenario 4.3 Mesenteric Ischemia

2. ECG

3. Chest X-ray

4. Abdominal X-ray

5. Abdominal CT Slice

6. 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.

7. CBC WBC17.310 000-30 000/mm 3 HGB16.311-15 g/dL HCT4840-50% PLT317150 000-450 000/mm 3

8. BMP Glucose12265-100 mg/dL BUN345-20 mg/dL Sodium141136-145 meq/L Potassium3.53.5-5.5 meq/L Chloride100100-106 meq/L CO 2 1322-32 meq/L Creatinine1.30.2-1.4 mg/dL

9. Cardiac Enzymes Troponin<0.001<0.05 ng/mL CK5526-140 IU/L CKMB1.50-8 ng/mL

10. Coagulation Panel PT1611.0-15.0 s INR1.30-4.0 PTT28.024.0-36.0 s

11. Urinalysis Clarityclear Coloryellow Glucosenegativenegative mg/dL Bilirubinnegative Ketonesnegativenegative mg/dL Sp. grav.1.0401.003-1.040 Bloodnegative pH5.05.0-8.0 Proteinnegativenegative mg/dL Urobilinogen0.10.2 EU/dL Nitritesnegative Leukocytesnegative

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

13. Hepatic Function Panel AST3219-48 U/L ALT1817-60 U/L Alk. phos.10556-119 U/L T. Bili0.80.4-1.5 mg/dL Albumin4.13.2-4.6 g/dL GGT3412-58 U/L

14. Lipase 3021-53 U/L

15. Lactate 10.10.5-2.2 mmol/L