Physical examination
Describe the patient’s body habitus
integer
Estimate abdominal aortic diameter by palpation
float
Indicate the presence of abdominal bruit
boolean
Examine the lower rectum to check for abnormalities in the rectum and stool (hemoccult).
text
Occult blood present?
boolean
Laboratory Testing
Amylase Indicate the following: ● Date of test ● Value ● Unit of measurement ● Normal range
float
Lipase Indicate the following: ● Date of test ● Value ● Unit of measurement ● Normal range
float
Stool fat content ● Microscopic: Indicate the number of stainable lipid globules per high-powered microscope field. ● Gravimetric: Indicate the collection period (number of days), reference range, and test result in grams of lipid per 24 h. ● Titrimetric
float
Fecal occult blood present?
boolean
Noninvasive Diagnostic Procedures
Mesenteric Artery Duplex Ultrasound Date of procedure Operator name Peak systolic velocity measurements ● Aorta ● Celiac artery ● Superior mesenteric artery ● Inferior mesenteric artery Ratio of mesenteric artery to aorta peak systolic velocities: Record ratio for celiac, superior mesenteric, and inferior mesenteric arteries. Location of stenosis: ● Celiac artery ● Superior mesenteric artery ● Inferior mesenteric artery Category of stenosis: Specify for celiac, superior mesenteric, and inferior mesenteric arteries. Choose 1 of the following: ● 0–69% ● 70%–99% ● Occlusion
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Computed Tomographic Angiography Date of procedure Contrast used: ● Ionic contrast ● Nonionic contrast; specify: — Monomer — Dimer Contrast volume [ml] Artery imaged: ● Celiac artery ● Superior mesenteric artery ● Inferior mesenteric artery Location of stenosis Artery stenosis:Indicate the severity of stenosis by quantitative analysis using the formula 100x(1-minimum lumen diameter)/maximum diameter of reference segment Aneurysm: Dilation of a mesenteric artery to a diameter >=1.5 times the nondilated diameter Thickening of the small or large bowel wall: yes/no Free air in the abdomen: yes/no Mesenteric venous thrombosis: Patent venous opacification of the superior mesenteric vein and portal vein Pneumatosis coli: yes/no
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Magnetic Resonance Angiography Date of procedure Contrast use: yes/no Artery imaged: ● Celiac artery ● Superior mesenteric artery ● Inferior mesenteric artery Location of stenosis Artery stenosis: Indicate the severity of stenosis by quantitative analysis using the formula 100x(1-minimum lumen diameter)/maximum diameter of reference segment Aorta: Identify atherosclerosis, stenosis, occlusion, and/or aneurysm of the abdominal aorta. Thickening of the small or large bowel wall: yes/no Free air in the abdomen: yes/no Mesenteric venous thrombosis: Patent venous opacification of the superior mesenteric vein and portal vein Pneumatosis coli: yes/no
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Diagnostic Testing: Invasive procedures
Date of procedure Operator name Artery imaged: ● Celiac artery ● Superior mesenteric artery ● Inferior mesenteric artery Artery stenosis: Indicate the severity of stenosis by quantitative analysis using the formula 100x(1-minimum lumen diameter)/maximum diameter of reference segment Aorta: Identify atherosclerosis, stenosis, occlusion, and/or aneurysm of the abdominal aorta. Diffuse vasospasm: Indicate the presence or absence of vasospasm consistent with nonocclusive mesenteric ischemia. Mesenteric venous thrombosis: Indicate whether the superior mesenteric vein and portal vein are patent or occluded by thrombus.
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