Gi mesenteric ischemia search mesenteric ischemia, acute mesenteric ischemia, mesenteric infarction, mesenteric venous thrombosis, colonic ischemia, intestinal ischemia, colonic vasculitis, ischemic colitis see also chronic mesenteric ischemia (abdominal angina) superior mesenteric artery occlusion pathophysiology watershed blood supply areas most often affected splenic flexure rectosigmoid epidemiology uncommon condition (but requires high index suspicion) accounts for 1% of acute abdominal pain admits more common in elderly males more commonly affected risk factors atherosclerosis myocardial infarction (recent) atrial fiibrillation dilated cardiomyopathy hypovolemia valvular disease advanced age intra-abdominal cancer rapid weight loss (e. how get prescription viagra viagra 20mg how much viagra cost in canada G. generic viagra pills buy generic viagra online Anorexia) results in decreased fat between duodenum and superior mesenteric artery ischemia results from duodenal compression of the superior mesenteric artery causes primary acute mesenteric ischemia (intravascular) superior mesenteric artery occlusion superior mesenteric artery embolism (50%) superior mesenteric artery thrombosis (15-25%) nonocclusive mesenteric ischemia - nomi (20-30%) mesenteric venous thrombosis (5-10%) causes primary chronic mesenteric ischemia (abdominal angina) see chronic mesenteric ischemia causes secondary mesenteric ischemia (compression) adhesions herniation volvulus intussusception tumor trauma retroperitoneal fibrosis symptoms abdominal pain severe and out of proportion to exam pain is poorly localized left lower quadrant abdominal cramping may occur gastroenteritis-type symptoms (one third of cases) diarrhea superior mesenteric artery embolism superior mesenteric artery thrombosis nausea and vomiting superior mesenteric artery embolism mesenteric venous thrombosis signs general abdominal tenderness to palpation fever fecal occult blood positive in 25% of cases timing sudden onset abdominal pain superior mesenteric artery embolism mesenteric venous thrombosis gradual onset abdominal pain superior mesenteric artery thrombosis nonocclusive mesenteric ischemia (nomi) labs diagnosis complete blood count (cbc) leukocytosis >15,000 with left shift is common serum phosphate level increases within 4 hours (75%) labs abnormal if bowel perforation occurs arterial blood gas (abg) with metabolic acidosis serum amylase increased serum lactate increased labs other basic metabolic panel (. cheap viagra viagra without a dosctor prescription viagra from canada viagra usa