Mesenteric ischemia diagnosis

[WashMe]

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on kaplan's MTB step 2ck, latest edition, p. 385, it has a question where a guy comes in with a clear hx for mesenteric ischemia and it asks "what is the most appropriate next step in management?" It lists both Abd CT and angiography in the answer choices. The answer explanation says that angiography is the next step, but then the very next page (p.386) says that Abd CT is the best "initial step" in work-up of suspected ischemic bowel disease, while angiography is the "most accurate" test...

So my question is, what is the appropriate thing to get first (according to USMLE)?

Thanks!

 

[ASAPRocky]

often they won't give u controversial topics. Next best step = CT, diagnostic = angiography. They most likely won't give u both.

 

[OveractiveBrain]

on kaplan's MTB step 2ck, latest edition, p. 385, it has a question where a guy comes in with a clear hx for mesenteric ischemia and it asks "what is the most appropriate next step in management?" It lists both Abd CT and angiography in the answer choices. The answer explanation says that angiography is the next step, but then the very next page (p.386) says that Abd CT is the best "initial step" in work-up of suspected ischemic bowel disease, while angiography is the "most accurate" test...

So my question is, what is the appropriate thing to get first (according to USMLE)?

Thanks!

This is trixy. If you have a high pretest probability for mesenteric ischemia, it is the angiography you want. It is not a controversial topic. If you wait for CT scan findings to become positive, it is already too late. Angiography can give you (A) the answer, and (B) potential for therapeutics. If you suspect mesenteric ischmia (risk factors for thromboemoblic disease, intestinal angina previously, pain out of proportion with teh abdominal exam), then you SHOULD get angiography.

The question is asking "do you consult a specialist (angiography) or do you try to work it out yourself (CT)." IRL, the ER doc will have gotten the CT scan. What he should have done was call vascular surgery / interventional cardiology.

The answer is get an angiography

 

[WashMe]

This is trixy. If you have a high pretest probability for mesenteric ischemia, it is the angiography you want. It is not a controversial topic. If you wait for CT scan findings to become positive, it is already too late. Angiography can give you (A) the answer, and (B) potential for therapeutics. If you suspect mesenteric ischmia (risk factors for thromboemoblic disease, intestinal angina previously, pain out of proportion with teh abdominal exam), then you SHOULD get angiography.

The question is asking "do you consult a specialist (angiography) or do you try to work it out yourself (CT)." IRL, the ER doc will have gotten the CT scan. What he should have done was call vascular surgery / interventional cardiology.

The answer is get an angiography

Thanks! 🙂

 

[NRAI2001]

This is trixy. If you have a high pretest probability for mesenteric ischemia, it is the angiography you want. It is not a controversial topic. If you wait for CT scan findings to become positive, it is already too late. Angiography can give you (A) the answer, and (B) potential for therapeutics. If you suspect mesenteric ischmia (risk factors for thromboemoblic disease, intestinal angina previously, pain out of proportion with teh abdominal exam), then you SHOULD get angiography.

The question is asking "do you consult a specialist (angiography) or do you try to work it out yourself (CT)." IRL, the ER doc will have gotten the CT scan. What he should have done was call vascular surgery / interventional cardiology.

The answer is get an angiography

Nice explanation.. thanks 👍 So many things I just glanced over!!