A 57-year-old man presents with 2 days of severe, generalized, abdominal pain that is worse after meals. He is also nauseated and reports occasional diarrhea mixed with blood. Apart from essential hypertension, his medical history is unremarkable. His vital signs include a temperature of 36.9°C (98.4°F), blood pressure of 145/92 mm Hg, and an irregularly irregular pulse of 105/min. Physical examination is only notable for mild periumbilical tenderness. Which of the following is the most likely diagnosis?
ADiverticular disease
BAcute pancreatitis
CGastroenteritis
DCrohn's disease
EAcute mesenteric ischemia
A 68-year-old woman is brought to the emergency department with intense abdominal pain for the past 2 hours. She has had 1 episode of bloody diarrhea recently. She has an 18-year history of diabetes mellitus. She was diagnosed with hypertension and ischemic heart disease 6 years ago. She is fully alert and oriented. Her temperature is 37.5°C (99.5°F), blood pressure is 145/90 mm Hg, pulse is 78/min, and respirations are 14/min. Abdominal examination shows mild generalized abdominal tenderness without guarding or rebound tenderness. An abdominal plain X-ray shows no abnormalities. Abdominal CT reveals colonic wall thickening and pericolonic fat stranding in the splenic curvature. Bowel rest, intravenous hydration, and IV antibiotics are initiated. Which of the following is the most important diagnostic evaluation at this time?
AAngiography
BGastrografin-enhanced X-ray
CLaparotomy
DInpatient observation
ESigmoidoscopy
A 63-year-old man is brought to the emergency department for the evaluation of severe abdominal pain that started suddenly 1 hour ago while he was having a barbecue with his family. The pain is located in the middle of his abdomen and he describes it as 9 out of 10 in intensity. The patient feels nauseated and has vomited twice. He has also had a loose bowel movement. He was diagnosed with hypertension 2 years ago and was started on hydrochlorothiazide. He stopped taking his pills 1 week ago because of several episodes of heart racing and dizziness that he attributes to his medication. The patient has smoked one pack of cigarettes daily for the last 40 years. He is in severe distress. His temperature is 37.6°C (99.7°F), pulse is 120/min, respirations are 16/min, and blood pressure is 130/90 mm Hg. Cardiac examination shows an irregularly irregular rhythm. Bowel sounds are normal. The abdomen is soft and nontender. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 16.8 g/dL Leukocyte count 13,000/mm3 Platelet count 340,000/mm3 Prothrombin time 13 seconds Partial thromboplastin time 38 seconds Lactate (venous) 2.4 mEq/L (N=0.5 - 2.2 mEq/L) Serum Urea Nitrogen 15 mg/dL Creatinine 1.2 mg/dL Lactate dehydrogenase 105 U/L CT angiography is performed and the diagnosis is confirmed. Which of the following is the most appropriate definitive management of this patient?
AAnticoagulation with heparin
BMR angiography
CColonoscopy
DPiperacillin/tazobactam administration
EBalloon angioplasty and stenting
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