Scenario 4.3

Mesenteric Ischemia

ECG

Chest X-ray

Abdominal X-ray

Abdominal CT Slice

STUDY: Abdomen/Pelvis CT

FINDINGS:CT obtained with limited contrast. Shows mild dilation of small and large bowel with mild to moderate fluid air levels present on several cuts. Thickening in the bowel wall noted and appears to be air inside the mesenteric vessels and the bowel wall itself in the territory of the superior mesenteric artery. No free air or significant free fluid is seen. No other abnormality seen.

IMPRESSION:Apparent ileus with likely pneumotosis intestinalis – clinical correlation is recommended.

CBC

WBC 17.3 10 000-30 000/mm3

HGB 16.3 11-15 g/dL

HCT 48 40-50%

PLT 317 150 000-450 000/mm3

BMP

Glucose 122 65-100 mg/dL

BUN 34 5-20 mg/dL

Sodium 141 136-145 meq/L

Potassium 3.5 3.5-5.5 meq/L

Chloride 100 100-106 meq/L

CO2 13 22-32 meq/L

Creatinine 1.3 0.2-1.4 mg/dL

Cardiac Enzymes

Troponin <0.001 <0.05 ng/mL

CK 55 26-140 IU/L

CKMB 1.5 0-8 ng/mL

Coagulation Panel

PT 16 11.0-15.0 s

INR 1.3 0-4.0

PTT 28.0 24.0-36.0 s

UrinalysisClarity clear

Color yellow

Glucose negative negative mg/dL

Bilirubin negative negative

Ketones negative negative mg/dL

Sp. grav. 1.040 1.003-1.040

Blood negative negative

pH 5.0 5.0-8.0

Protein negative negative mg/dL

Urobilinogen 0.1 0.2 EU/dL

Nitrites negative negative

Leukocytes negative negative

Urine microscopy

Urine RBC None seen NS/HPF

Urine WBC NS/HPF NS/HPF

Urine epithelial cells

NS/HPF NS/HPF

Urine bacteria None seen /HPF

Urine casts None seen NS/LPF

Hepatic Function PanelAST 32 19-48 U/L

ALT 18 17-60 U/L

Alk. phos. 105 56-119 U/L

T. Bili 0.8 0.4-1.5 mg/dL

Albumin 4.1 3.2-4.6 g/dL

GGT 34 12-58 U/L

Lipase

Lipase 30 21-53 U/L

Lactate

Lactate 10.1 0.5-2.2 mmol/L