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Acute mesenteric ischaemia — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAcute mesenteric ischaemiaRCPSC EM

A 74-year-old with atrial fibrillation has sudden severe abdominal pain out of proportion to examination. Lactate is 5.8 mmol/L, WBC 18, creatinine 156 µmol/L, and ECG shows AF with rapid ventricular response. What is the most likely diagnosis?

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Correct answer: A — Acute mesenteric ischaemia

Severe pain out of proportion, metabolic lactic acidosis and embolic risk from AF are classic for acute mesenteric ischaemia.

Reference: Canadian Association of General Surgeons acute abdomen principles; emergency medicine vascular surgery standards