Case02

A 62-year-old patient complains of rapid onset of severe left abdominal pain that has been increasing over the past 3 hours. The patient indicates they has had nausea and vomiting associated with the pain. On examination, their abdomen has normal bowel sounds. Blood is present in a stool specimen. Bloodwork shows a pronounced low bicarbonate level with a matching increase in serum lactate level. They has a history of myocardial ischemia and vascular disease, including extensive calcifications of their aorta and a thoracic aortic aneurysm repair several years ago.

Incorrect. While constipation may cause painful cramps, it usually would not induce extreme nausea and blood in the stool.

Incorrect. A myocardial infarct, would not explain the blood in the stool. Myocardial pain typically refers to the chest, epigastrium or to the left shoulder, rather than the described abdominal left side pain.

Incorrect. Pain from gallstones would be on the right, not the left, with possible referred pain to the right scapula. Further, gallstones would not be consistent with the bloodwork or presence of blood in the stool.

Incorrect. Peritonitis would result in abdominal pain and discomfort in a more generalized manner, but would not directly result in the electrolyte levels.

Correct! This patient complained of sudden onset of severe left side abdominal pain that is out of proportion to the physical findings. The presence of blood in the stool suggests bowel injury and bleeding into the gastrointestinal tract lumen.

They have a history of widespread atherosclerotic vascular disease affecting the aorta and history of aneurysm. This could be a generalized reduction of flow through the vasculature of the gastrointestinal system. Arteriography of the abdominal vasculature might be diagnostic to determine if the occlusion is localized (one branch) or generalized (ischemic colitis). The mortality rate is high in patients with ischemic colitis.