Question:medium

An elderly man with a history of atrial fibrillation presents with sudden severe abdominal pain that is out of proportion to physical findings. Which laboratory finding most strongly supports the diagnosis of acute mesenteric ischemia?

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Dying gut means anaerobic metabolism - look at the lactate.
Updated On: Jun 25, 2026
  • Raised serum lactate (and LDH)
  • Raised serum amylase only
  • Hypocalcaemia
  • Raised serum bilirubin
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The Correct Option is A

Solution and Explanation

Atrial fibrillation throws clots; when one travels to the superior mesenteric artery, the small bowel is suddenly starved of blood. The classic clue is agonising pain with a deceptively soft, benign-looking abdomen.

Starved tissue switches to anaerobic glycolysis, dumping lactate into the blood, and as cells die they spill lactate dehydrogenase. So the lab signature is a rising serum lactate (driving a high-anion-gap metabolic acidosis) together with elevated LDH.

Amylase is too non-specific to clinch it, and neither calcium nor bilirubin track this disease.

\[ \text{AF embolus} + \text{pain out of proportion} + \uparrow\text{lactate}/\text{LDH} \Rightarrow \text{acute mesenteric ischemia} \]

\[\boxed{\text{Raised serum lactate / LDH}}\]
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