Mesenteric ischemia diagnostic study of choice: Difference between revisions

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Revision as of 20:12, 6 January 2018

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

Overview

The defintive diagnosis of mesenteric ischemia relies mainly on the imaging studies of which the most accurate is high resolution computed tomographic angiography. It demonstrates the site of occluion in the vessels as well as helps determine the choice of treatment opted.

Diagnostic Study of Choice

Gold standard/Study of choice for mesenteric ischemia:

High resolution computed tomographic angiography (HRCTA) is the gold standard test for the diagnosis of mesenteric ischemia for the following reasons:
- Confirms the diagnosis
- Determines the prognosis
- Identifies collateral circulation
- Potential sources of inflow
- Determines the type of occlusion

Acute embolic mesenteric occlusion shows:

Chronic mesenteric ischemia:

Mesenteric ischemia is primarily a radiological diagnosis.
The following results of CTA is confirmatory of mesenteric ischemia:

Sensitivity and specificity:^[1]

Do	Sensitivity	Specificity
High resolution computed tomographic angiography	94%	95%

✔= The best test based on the feature

Diagnostic results

The following result of computed tomographic angiography is confirmatory of mesenteric ischemia:

Findings
Classic meniscus sign	Seen at the point of occlusion more commonly in acute Proximal jejunal branches are filled quickly whereas distal branches are visualized minimally.
Multiple areas of narrowing and irregularity	More commonly seen in non-occlusive mesenteric ischemia

Sequence of Diagnostic Studies

The [name of investigation] should be performed when:

The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
A positive [test] is detected in the patient, to confirm the diagnosis.

References

Template:WH Template:WS

↑ Cudnik, Michael T.; Darbha, Subrahmanyam; Jones, Janice; Macedo, Julian; Stockton, Sherrill W.; Hiestand, Brian C.; Jones, Alan E. (2013). "The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis". Academic Emergency Medicine. 20 (11): 1087–1100. doi:10.1111/acem.12254. ISSN 1069-6563.

[CudnikDarbha2013-1] Cudnik, Michael T.; Darbha, Subrahmanyam; Jones, Janice; Macedo, Julian; Stockton, Sherrill W.; Hiestand, Brian C.; Jones, Alan E. (2013). "The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis". Academic Emergency Medicine. 20 (11): 1087–1100. doi:10.1111/acem.12254. ISSN 1069-6563.

[1]

@@ Line 7: / Line 7: @@
 == Diagnostic Study of Choice ==
-=== Gold standard/Study of choice: ===
+=== Gold standard/Study of choice for mesenteric ischemia: ===
-* High resolution computed tomographic angiography is the gold standard test for the diagnosis of mesenteric ischemia for the following reasons:
+* High resolution computed tomographic angiography (HRCTA) is the gold standard test for the diagnosis of mesenteric ischemia for the following reasons:
-** Determines the type of occlusion
+** Confirms the diagnosis
+** Determines the prognosis
 ** Identifies collateral circulation
 ** Potential sources of inflow
-* Cirrhosis is primarily a [[Histology|histological]] diagnosis. [[Liver biopsy]] is the gold standard test for the diagnosis of cirrhosis.
+** Determines the type of occlusion
-* The following result of [[liver biopsy]] is confirmatory of cirrhosis:
+Acute embolic mesenteric occlusion shows:
-** Presence of bridging fibrous [[Septum (disambiguation)|septa]]
-** Parenchymal [[Nodule (medicine)|nodules]] bearing a mixture of replicating and sensecent [[Hepatocyte|hepatocytes]]
+Chronic mesenteric ischemia:
-** Involvement of most or all of the [[liver]]
+* Mesenteric ischemia is primarily a radiological diagnosis.
-* [[Liver biopsy]] should be performed in order to:
+* The following results of CTA is confirmatory of mesenteric ischemia:
-** Confirm the [[diagnosis]]
+*
-** Determine prognosis
+*
-** Diagnose the underlying [[etiology]] of cirrhosis
-*** [[Alcoholic liver disease]] : [[Liver biopsy]] may show [[hepatocyte]] necrosis, presence of [[Mallory body|mallory bodies]], neutrophilic infiltration and perivenular inflammation
-*** [[Primary biliary cirrhosis|Primary biliary cirrhosis]] : [[Gold standard (test)|Gold standard diagnostic modality]] is the detection of [[antimitochondrial antibodies]] along with [[liver biopsy]] as confirmation if florid [[bile duct]] lesions
-** Manage and evaluate [[Transplant rejection|rejection]] subsequent to [[liver transplantation]]
-** Evaluate abnormal [[Liver|hepatic]] investigations
-** Rule out [[Liver|hepatic]] [[Neoplasm|neoplasms]]
-** Diagnose [[Cholestasis|cholestatic]] [[liver]] disease
-** Evaluate infiltrative or [[Granuloma|granulomatous]] disease
-** Evaluate unexplained [[jaundice]]
-** Evaluate [[Adverse drug reaction|drug reactions]]
-** Monitor progression of diseases such as [[primary biliary cirrhosis]], [[Hepatitis C|chronic hepatitis C]]<sup> </sup>or [[alcoholic liver disease]]
-* Cirrhosis is mainly diagnosed based on clinical presentation, [[Medical laboratory|laboratory]], and [[Radiologic sign|radiologic]] data.
 '''Sensitivity and specificity:'''<ref name="CudnikDarbha2013">{{cite journal|last1=Cudnik|first1=Michael T.|last2=Darbha|first2=Subrahmanyam|last3=Jones|first3=Janice|last4=Macedo|first4=Julian|last5=Stockton|first5=Sherrill W.|last6=Hiestand|first6=Brian C.|last7=Jones|first7=Alan E.|title=The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis|journal=Academic Emergency Medicine|volume=20|issue=11|year=2013|pages=1087–1100|issn=10696563|doi=10.1111/acem.12254}}</ref>
 {|
@@ Line 74: / Line 63: @@
 * The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
 * A positive [test] is detected in the patient, to confirm the diagnosis.
-=== Diagnostic Criteria ===
-* Here you should describe the details of the diagnostic criteria.
-*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
-*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
-*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
-*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
-*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
-*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
-*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
-* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-** Criteria 1
-** Criteria 2
-** Criteria 3
-IF there are clear, established diagnostic criteria:
-*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-IF there are no established diagnostic criteria:
-*There are no established criteria for the diagnosis of [disease name].
 ==References==