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Question

Ischemic bowel disease has two classic presentations: acute and chronic.

1. What is the typical type of patient (or risk factors) for each?
2. How does each type classically present?

Answer

1. The risk factors for each type are a little different, but very important in differentiating the causes of abdominal pain:
   • Acute (from embolism)
     • atrial fibrillation, hypercoaguable states, instrumentation, valvular disease, and ventricular aneurysms
   • Chronic (from decreased perfusion)
     • peripheral vascular disease, atherosclerosis
2. The presentations for both are also vastly different:
   • Acute
     • sudden onset of severe, periumbilical abdominal pain that is out of proportion to physical examination
     • bloody stools may also occur
   • Chronic
     • post-prandial intestinal pain due to inability to meet the blood flow demands for digestion
     • patients may also lose weight due to “food fear”