Ischemic bowel

Question 1

60 yr lady presented with acute generalised abdominal pain and nausea ,you suspect ischemic bowel , what are the findings on plain AXR

Answer 1

dilated  small bowel loops 
 bowel wall thickening 
thumb printing 
negative findings 
 : no gas in rectum 
no intramural gas 
no free gas

Question 2

List 3 DD of this presentation

Answer 2

1- cholecystitis 
2- pancreatitis 
3- appendicitis 
4- diverticulitis 
5- AAA
6- bowel perforation 
7= renal colic

Question 3

Mx of ischemic bowel

Answer 3

1- surgical referral for assessment and planning for definitive treatment
2- analgesia IV fentanyl 25-50 mcg
3- NBM , NGT
4- IVF sodium chloride 20 ml/kg IV stat , aim for MAP >65mmhg
5- CT A/P with angiography to assess surgical planning and amenable for IR
6- IV AB ceftriaxone and metronidazole
7- antiemetics

Question 4

List indicators for poor prognosis in this patient

Answer 4

1- CT findings of pneumotosis intestinalis 
2- peritonism  exam
3- raised lactate 
4- haemodynamic instability 
5- bloody diarrhea