Mesenteric ischemia physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Physical examination of patients with mesenteric ischemia can be normal in early stages or there may be mild abdominal distension in the absence of peritonitis which presents as rebound tenderness and guarding. As the ischemia progresses to involve all the layers of the intestine (transmural infarction), abdomen becomes distended, peritoneal signs develop and bowel sounds become absent. A feculent odor of the breath may also be noticed. Signs of dehydration and shock may also appear if not treated in time.

• Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating).

The following findings are present if the patient presents in a state of shock or hemodyanamic instability:^[1]

• Tachycardia with irregular pulse in case of atrial fibrillation.
• Tachypnea

• Pallor is present in patients presenting with shock.

• Jugular venous distension in case of congestive heart failure.
• Carotid bruits may be auscultated unilaterally / bilaterally using the bell of the stethoscope in patients having atherosclerosis.

• S1 and S2 is loud if the patient presents in shock.
• S3 is present in case of congestive heart failure.

Abdominal examination shows the following findings in later stages of ischemia when transmural infarction has occured:^[2]

• Abdominal distention
• Generalized Abdominal tenderness
• Rebound tenderness
• Guarding may be present

• Cyanosis can be present in later stage of shock.