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Post-Prandial Pain

Scroll to bottom for case answer and E-meducation. 

History: A 78-year-old male returns to the ED for epigastric pain 4 days after his initial visit.  He states antacids are not helping and pain is triggered by food to the extent that he’s been afraid to eat because of this pain.  He denies any nausea vomiting diarrhea fever or other complaints.

PMH: 3 cm aortic aneurysm. High cholesterol. GERD. Hypertension..

Exam: Vital signs were.  Physical exam was normal with a non-tender abdomen

Labs: LFT’s normal.  BUN/Cr: 30/2.5 up from 26/1.8.  Lipase 72 down from 144

Imaging:  His renal function is abnormal and has worsened so a CT was again done without contrast which shows no definite explanation for his pain.

Initial Concern(s): gastritis, pancreatitis, AAA, ACS

Question(s): What other condition should you worry about?  What imaging should you consider?

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ANSWER: Consider Chronic Mesenteric Ischemia.  Get a CT angio, angiogram, MRI or mesenteric ultrasound.  Only the last two are contrast free

US SUPERIOR MESENTERIC  & CELIAC ARTERY FASTING & POST-PRANDIAL

Elevated velocities in the proximal and mid celiac artery. The velocity in the midportion of the celiac suggests a greater than 70% stenosis.

No significant stenosis is seen in the superior mesenteric artery.

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E-meducation “page-shot” on MESENTERIC ISCHEMIA from the Emergency Medicine 1-minute Consult Pocketbook

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