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www.gitfreed.a.i. Hey guys, what's going on? This is Mike Estefan from the University of Rochester

School of Medicine, bringing you episode 8 in the Emergency Medicine shelf exam review series.

We're going to begin where we left off last week, covering more causes of abdominal pain

that are high yield for your examination. All right, let's talk about acute mesenteric

ischemia. So the way this will be presented on the exam to you is an older patient coming in with

pain out of proportion to our physical examination.

Typically this patient will have a history of a fib or they will have had a recent embolectomy.

Both of these scenarios would predispose the patient to arterial-emolic events.

Now, what is the gold standard diagnostic test for acute mezzanteric ischemia?

Good.

Mezenteric angiography is the gold standard test and will be the correct answer on your exam.

Now let's say the next patient comes in and they're complaining of abdominal bloating and distension and on and off abdominal pain and their last bowel movement was like eight days ago. This scenario is concerning for a bowel obstruction.

Now if this pain is very severe or if they're parotinetic on exam,

what diagnostic test do you want to order first?

So this would be an upright chest x-ray to look for free air under the diaphragm.

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