doc4mindia
Forum Guru
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A 74-year-old man has had bloody diarrhea for three days. A plain radiograph of the abdomen shows an edematous dilated transverse colon and pancreatic calcification. There is no evidence of free intra-peritoneal air. Sigmoidoscopy to 14 cm shows edema but no other lesions.
The most likely diagnosis is:
a. acute ischemic colitis
b. chronic pancreatitis
c. infection with Shigella
d. pseudomembranous colitis
e. ulcerative colitis
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| mingle
Forum Senior
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Posts: 109
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ulcerative colitis. uc causes psc which is an extrahepatic sclerosis causing pancreatitis. the transverse colon is not a watershed area of blood suss & isn;t the ischaemia characteristically only after meals rather than ongoing for 3 days
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| doc4mindia
Forum Guru
Topics: 134
Posts: 243
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The answer is A
The most likely diagnosis in this patient is acute ischemic colitis. The radiograph shows inflammation and transverse colonic involvement; sigmoidoscopy shows normal mucosa. While similar inflammation patterns may be seen in patients with pancreatitis, a three-day history of bloody diarrhea makes this diagnosis tinlik"'Iy Patients with ulcerative colitis usually have inflammation of the rectum. Pseudomembranous colitis is common in older patients living in long-term-care facilities. Although patients frequently have bloody diarrhea, inflammation is rarely found above the rectum.
Bloody diarrhea may result from acute infection, but there is usually rectosigmoid involvement. Stools should be examined for fecal leukocytes and amebae. A stool culture should be performed to detect pathogenic organism such as Shigella, Campylobacter, Escherichia coli, and amebae.
Appropriate management of acute is-up, and if gangrene is suspected immediate surgery.
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