Acute mesenteric ischemia

Question 1

80M + atrial fibrillation + severe abdominal pain + physical exam shows mild tenderness to palpation; Dx?

Answer 1

acute mesenteric ischemia; pain out of proportion to physical exam is characteristic;
left atrial mural thrombus from AF launched off to SMA or IMA.

Question 2

What is acute mesenteric ischemia?

Answer 2

A condition characterized by reduced blood flow to the intestines, leading to severe abdominal pain.

Question 3

What is the first presentation of acute mesenteric ischemia on USMLE?

Answer 3

Severe abdominal pain in a patient with atrial fibrillation due to a left atrial mural thrombus launching off to the SMA or IMA.

Question 4

What is the second presentation of acute mesenteric ischemia on USMLE?

Answer 4

Severe abdominal pain in a patient who has just been cardioverted or defibrillated, where a left atrial thrombus can launch off to the SMA or IMA.

Question 5

What is the third presentation of acute mesenteric ischemia on USMLE?

Answer 5

Severe abdominal pain in a patient with a history of chronic mesenteric ischemia (i.e.,
acute on chronic) due to an atheroma within the SMA or IMA rupturing, effectively causing an “MI of the bowel.”

Question 6

What is the next best step in the management of acute mesenteric ischemia according to USMLE?

Answer 6

Mesenteric angiography.

I’ve never seen medications or endarterectomy as answers.

Question 7

What is an alternative answer for the next best step on NBME forms for acute mesenteric ischemia?

Answer 7

Laparotomy.

I’ve never seen medications or endarterectomy as answers.