This page is dedicated to organizing various examples of standardized exam questions whose answer is ischemic colitis. While this may seem a odd practice, it is useful to see multiple examples of how ischemic colitis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
Question # 1
A 65 year old male with a history of coronary artery disease and peripheral vascular disease recently underwent a coronary bypass surgery. After the operation his course was complicated by hypotension which was successfully treated with intravenous fluids. A few hours after restoring his blood pressure however he began to experience abdominal pain and bloody diarrhea. His temperature is 100.0 °F, blood pressure is 110/65 mm Hg, pulse is 108/min, and respirations are 21/min. A physical exam reveals normal bowel sounds, and there is no guarding or focal regions of tenderness. Lab studies are performed and shown below:
- Hemoglobin: 11.1 g/dL
- Platelets: 135,000/mm³
- Leukocytes: 8,400/mm³
- Sodium: 137 mEq/L
- Potassium: 4.3 mEq/L
- Blood urea nitrogen: 17 mg/dL
- Creatinine: 0.9 mg/dL
The patient’s venous lactic acid level is found to also be elevated. What is a possible diagnosis in this patient?
Explanation: older age + period of hypotension + abdominal pain + bloody diarrhea + increased lactic acid = ischemic colitis
Question # 2
A 78 year old male undergoes a surgical resection of a large abdominal aortic aneurysm. After the operation he develops a left lower quadrant abdominal pain, and also experiences bloody diarrhea. He has a past history of prostate cancer and received radiation therapy several years ago. His past medical history is notable for hypertension, pre-diabetes, and hypercholesterolemia. His vital signs are remarkable only for a low-grade fever. A physical exam shows tenderness in the left lower quadrant, and there is gross blood visible during a rectal exam. A CT-scan shows thickening of the colon at the rectosigmoid junction, however is otherwise unremarkable. What is the likely diagnosis in this patient?
Explanation: older age + recent aortic aneurysm operation + abdominal pain + bloody diarrhea + colon thickening on CT (inflammation/edema) = ischemic colitis
Page Updated: 03.11.2017