Physical findings in a patient with mesenteric ischemia

What are the physical findings in a patient with mesenteric ischemia? 

Again, the physical findings associated with mesenteric ischemia vary based on etiologic factors and duration of ischemia.

• The classic finding of a patient with an acute occlusion of the SMA is abdominal pain out of proportion to physical examination findings. Early in the course of the disease process the abdominal examination usually consists only of mild abdominal distension and normal or hypoactive bowel sounds. With progression of ischemic injury, bowel sounds decrease, ileus develops, and abdominal distension worsens. Stool becomes guaiac positive; sometimes grossly bloody stool may develop. Volume sequestration is manifested by hypotension and tachycardia, whereas fever and peritoneal signs are indications of transmural injury and likely infarction.

• Patients with venous occlusive disease present with physical examination findings based on the severity and etiologic characteristics of ischemia: congestive heart failure, abdominal mass, stigmata of chronic liver disease and portal hypertension, or hypercoagulability.

• NOMI should be suspected in the correct clinical setting. Patients present with early complaints that are less dramatic than those of patients with acute arterial occlusion; however, a small proportion of patients do not have abdominal pain. Physical examination findings vary with the duration of ischemia. Patients usually describe chronic, recurrent abdominal pain secondary to compromised flow through the SMA. There are no specific physical examination findings. Of note, most patients have evidence of peripheral vascular disease and may also have weight loss.

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