History:
-Hematochezia due to mucosal sloughing (right colon supplied by SMA)
-““Intestinal angina”: postprandial abd pain, early satiety, & decreased wt from gastric vascular “steal”; may occur wks to mos before the onset of acute pain in pts w/ chronic mesenteric ischemia” Pocket Medicine
Physical Exam:
-PE may be normal, or may only show abdominal distention
“-For AMI 2/2 to occlusion: Sudden abd pain out of proportion to abdominal tenderness on exam, at least initially (2–4 h) until severe ischemia leading frank infarction w/ peritoneal signs.
-AMI 2/2 to nonocclusive causes: abd distension & pain, though up to 25% may be pain-free, N/V; often in the setting of CHF +/- h/o chronic mesenteric ischemia sx
–Peritoneal signs (diffuse tenderness, rebound, guarding) suggest that bowel infarction has occurred.” Pocket Medicine
“The hallmark of acute mesenteric artery ischemia is severe abdominal pain that is out of proportion to physical findings. This is a life-threatening event, which often follows a myocardial infarction when a mural thrombus occludes a superior mesenteric artery. Patients rapidly become acidotic and hypotensive, and experience a high mortality rate.“ ABFM