new_n_lost
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A 71-year-old woman with a history of coronary artery disease presents to her family physician for a routine check-up. The physician notices that she has lost 10 kg since her last visit 6 months ago. When questioned, she gives a history of intermittent periumbilical pain that always begins 30 minutes after eating and lasts about 2 hours. She claims that the pain is worse after large meals and so she has begun to eat less out of fear of pain.
Which one of the following is the most likely diagnosis?
1) Pancreatitis
2) Cholecystitis
3) Small bowel obstruction
4) Intestinal ischemia
5) Peptic ulcer disease
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| me007
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2
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| monam84
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4. Intestinal ischemia - she has a history of CAD so she has some atherosclerosis already. About 30 minutes after eating the watershed area (splenic flexure) usually become ischemic and sumtimes pts can present with bloody stool because of a hemorrhagic infarct. The fear of eating is importnat.
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| keepgoing
Forum Guru
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yes between 4 and 5 more likely 4....
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| usmle4me
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Intestinal ischemia
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| peggy
Forum Newbie
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intestinal ishemia, 100%.
btw, the pain is also periumbilical, which is not that typical for cholecystitis. and if it was cholesytitis, for sure it would be mentioned fat woman, pain after fatty meal.
my 2 cents!
GL
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| new_n_lost
Politically InCorrect
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U Guys r good I choose Cholecystitis but alas it wasnt the answer.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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Posts: 6,086
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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Patients with mesenteric ischemia have a very typical presentation. However, the diagnosis may be overlooked because of the vague nature of the patients' symptoms. Depending on the type of mesenteric ischemia, patients may present with a variety of signs and symptoms. Patients may present with a history of postprandial pain, typically starting 20-30 minutes after their last meal, that may last up to 60-90 minutes. Because of this, they develop food fear and experience subsequent weight loss. Patients may be severely malnourished upon presentation.
Some patients may present with an acute onset of severe abdominal pain without a history of previous postprandial pain. These patients may report blood in their stool as their bowel begins to die. The classic patient with chronic mesenteric ischemia may provide a history of postprandial pain between 10 minutes and 3 hours after a meal. The pain can become so severe that the patient may develop a fear of eating and report recent weight loss. Patients may report diarrhea or constipation, and occult testing of stool may return positive results because of the sloughing of dead ischemic bowel.
Patients with acute mesenteric ischemia provide a history of sudden onset of symptoms. Further exploration may reveal a history similar to persons with chronic ischemia. Review of the past medical history may reveal other manifestations of atherosclerotic disease such as MI, stroke, or peripheral vascular disease.
Upon physical examination, the patient is thin and writhing in pain. Palpation of the abdomen reveals no peritoneal signs (pain out of proportion to examination), and auscultation of the abdomen may reveal a bruit.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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