Diagnostic studies-acute mesenteric ischemia

• Dx relies on high level of suspicion; rapid dx essential to avoid infarction (occurs w/in hrs)

• Mortality 20 to >70% if bowel infarcted; dx prior to infarction strongest predictor of survival

• Laboratory: often nl; ~75% ↑ WBC; ↑ amylase, LDH, PO4, D-dimer; ~50% ↑ lactate (late)

• KUB: nl early before infarct; “thumbprinting,” ileus, pneumatosis in later stages

• CT angiography (arterial phase): noninvasive test of choice; venous phase for dx MVT

• Angiography: gold standard; potentially therapeutic; indicated if vasc occlusion suspected