robin082006
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3) A 74-year-old woman presents complaining of very severe abdominal pain, which began abruptly 8 hours ago. She describes the pain as "the worst I've ever had." On questioning, she is unable to give a precise location but indicates that her entire mid-abdomen is extremely painful. She has been followed for the past 10 years for symptoms of congestive heart failure after she had an anterior wall myocardial infarction. She has remained relatively well controlled with only occasional dyspnea on exertion. Her medications include captopril, furosemide, digoxin, isosorbide dinitrate, and aspirin. She has not had any prior surgery. On physical examination, she appears extremely uncomfortable. Her temperature is 38.9 C (101.9 F), blood pressure is 174/102 mm Hg, and pulse is 118/min and irregularly irregular. On cardiac examination, there is a regular heart rhythm with a II/VI holosystolic murmur heard best at the apex and radiating to the axilla. She has an irregularly irregular S1 and S2, and scattered bibasilar rales. An abdominal examination reveals mild distention and no hepatosplenomegaly. The abdomen is diffusely soft but very tender to palpation. A rectal examination reveals brown, guaiac-positive stool. She has no audible bowel sounds. Which of the following is the most likely diagnosis?
A. Diverticulitis
B. Ischemic colitis
C. Mesenteric ischemia
D. Pancreatitis
E. Small bowel obstruction
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| ssrpk
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C. Mesenteric ischemia
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| euclid58
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I think its ischemic colitis, she has fever and guaiac positive stools pointing towards colitis rather than mesenteric ischemia
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| jvo_md
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That's a mesenteric ischemia anywhere in the world
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| robin082006
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answer is C
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| The-surgeon
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C.mesentric ischemia
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