Abdominal Pain: Beyond the Obvious Symptoms

An article in the current month’s edition of Critical Care Nursing seeks to raise awareness of an uncommon, but lethal cause of abdominal pain in acute and critically ill patients. The condition, mesenteric ischemia and infarction (MI), produces symptoms similar to more common gastrointestinal disorders, including appendicitis, irritable bowel syndrome, ulcers, colon cancer, and abdominal aortic aneurysm. By ruling out these possibilities, and being alert for the more uncommon diagnosis of MI, the article suggests that nurses can help at-risk patients to receive the appropriate interventions more quickly. Coauthor Rosemary Lee, DNP, ARNP, ACNP-BC, CCRN, CCNS, clinical nurse specialist for critical and progressive care at Homestead Hospital in Florida, commented, “Looking at only the most common causes for complications can lead to a delay in diagnosis, which can be deadly in cases of mesenteric ischemia.”

The article, entitled “MI: Not a Heart Attack but a Gut Attack” outlines the different variations of arterial and venous MI of the small bowel, which are accompanied by a mortality rate of 50% to 60%. Acute MI due to thrombus may make patients appear to have unstable angina. Acute MI from embolus may cause patients to present with uncharacteristically severe abdominal pain, along with nausea and vomiting. MI may also be accompanied by intestinal angina, provoking cramps and other types of pain and discomfort. Lee noted, “Time is of the essence for these patients, and nurses with a high level of suspicion can look beyond the often vague and confusing symptoms.”

Read a news story about the recommendations, with a link to the journal article.