Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Ischemic Bowel Disease 875

■Total loss of perfusion from catastrophic thrombosis or embolus –

“dead bowel” – severe abdominal pain with cardiovascular collapse

and sepsis; a surgical emergency

tests

Laboratory Tests

■Usually some elevation of WBC and left shift

■Elevated serum amylase and/or lipase if proximal small bowel

ischemia

■Anion gap acidosis and lactic acidosis late manifestations – often too

late to have meaningful impact on outcome

■Usually hemoconcentrated; not anemic

Radiography

■Plain radiographs rarely specific – may show “thumbprints” of ede-

matous bowel wall, air in wall of bowel or portal venous air. Rarely

show “free air”

■Contrast radiography – barium enema and UGI series show edema-

tous bowel wall; do not do barium exams prior to CT

■CT scans – very helpful at suggesting diagnosis – need IV, oral and

rectal contrast – show edematous bowel wall (thickened valvulae of

small bowel and/or haustra), air in bowel wall and portal venous

air

Endoscopy

■Rarely see actual small bowel ischemia – may rule out other causes

of abdominal pain

Colonoscopy

■Very helpful – classic findings, normal rectum yet submucosal hem-

orrhages and shallow ulcers beginning in segmental distribution

Angiography:

■Helpful only for acute emboli/thrombosis or to identify severe

■ASCVD

differential diagnosis

■Early clinical manifestations often dismissed as trivial/self-limited

■Major differential diagnoses:

➣Appendicitis – CT helpful here

➣Peptic ulcer disease – endoscopy helpful to exclude