373) A 70 year old woman presents to the emergency room with complaints of abdominal pain for the past one day. The pain is in in lower abdomen and is mild to moderate. It has started suddenly and is persistent. She also reports having had two episodes of loose and bloody stools this morning. Her past medical history is significant for coronary artery disease, hypertension and chronic kidney disease. On examination, she is afebrile, blood pressure is 130/80 mm Hg, pulse 90/min and respiratory rate 18/min. Cardiac examination reveals normal and regular heart sounds without murmurs. There is tenderness in the left lower quadrant of the abdomen. There is no rebound tenderness or rigidity. The patient is started on intravenous fluids. Stool studies reveal blood but no leukocytes. Clostridium difficle toxin is negative. Stool cultures are sent. Complete blood count shows White blood cell count at 20,000/µl with left shift. She is started on IV hydration. Which of the following is the most likely diagnosis?
A) Mesenteric Infarction
B) Acute Diverticulitis
C) Acute Mesenteric Ischemia
D) Ischemic Colitis
E) Inflammatory Bowel Disease
374) The patient in the above question undergoes appropriate diagnostic work up and the diagnosis is confirmed. Which of the following is the most appropriate next step in management ?
A) Broad spectrum antibiotics
B) Mesenteric angiography
C) Obtain Surgery Consult
D) Percutaneous Transluminal Angioplasty and Mestenteric stent
E) Start Methylprednisolone and Mesalmaine