A 53-year-old woman comes to the emergency department because of weakness and abdominal pain for 24 hours. She has had three bowel movements with dark stool during this period. She has not had vomiting and has never had such episodes in the past. She underwent a tubal ligation 15 years ago. She has chronic lower extremity lymphedema, osteoarthritis, and type 2 diabetes mellitus. Her father died of colon cancer at the age of 72 years. Current medications include metformin, naproxen, and calcium with vitamin D3. She had a screening colonoscopy at 50 years of age which was normal. She appears pale and diaphoretic. Her temperature is 36°C (96.8°F), pulse is 110/min, respirations are 20/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. The abdomen is soft and nondistended with mild epigastric tenderness. Rectal exam shows tarry stool. Two large bore IV lines are placed and fluid resuscitation with normal saline is initiated. Which of the following is the most appropriate next step in management?
AEsophagogastroduodenoscopy
BCT scan of the abdomen with contrast
CFlexible sigmoidoscopy
DDiagnostic laparoscopy
EColonoscopy
A 26-year-old white man comes to the physician because of increasing generalized fatigue for 6 months. He has been unable to work out at the gym during this period. He has also had cramping lower abdominal pain and diarrhea for the past 5 weeks that is occasionally bloody. His father was diagnosed with colon cancer at the age of 65. He has smoked half a pack of cigarettes daily for the past 10 years. He drinks 1–2 beers on social occasions. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 116/74 mm Hg. Physical examination shows dry mucous membranes. The abdomen is soft and nondistended with slight tenderness to palpation over the lower quadrants bilaterally. Rectal examination shows stool mixed with blood. His hemoglobin concentration is 13.5 g/dL, leukocyte count is 7,500/mm3, and platelet count is 480,000/mm3. Urinalysis is within normal limits. Which of the following is the most appropriate next step in management?
AD-xylose absorption test
BCT scan of the abdomen and pelvis with contrast
CCapsule endoscopy
DColonoscopy
EFlexible sigmoidoscopy
A 64-year-old woman has progressively worsening abdominal pain 5 hours after an open valve replacement with cardiopulmonary bypass. The pain is crampy and associated with an urge to defecate. The patient reports having had 2 bloody bowel movements in the last hour. Her operation was complicated by significant intraoperative blood loss, which prolonged the operation and necessitated 2 transfusions of red blood cells. She has hypercholesterolemia and type 2 diabetes mellitus. The patient received prophylactic perioperative antibiotics and opioid pain management during recovery. Her temperature is 37.9°C (98.9°F), pulse is 95/min, and blood pressure is 115/69 mm Hg. Examination shows a soft abdomen with mild tenderness to palpation in the left quadrants but no rebound tenderness or guarding. Bowel sounds are decreased. Rectal examination shows blood on the examining finger. Which of the following is the most likely underlying cause of this patient's symptoms?
AEmbolization of superior mesenteric artery
BAtherosclerotic narrowing of the intestinal vessels
CSmall outpouchings in the sigmoid wall
DInfection with Clostridioides difficile
EDecreased blood flow to the splenic flexure
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