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  #1  
Old 07-31-2011
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Question Diagnose the autopsy finding

A 60-year-old man has worsening dyspnea and swelling of his legs for the past month. On physical examination he has pitting edema to the hips as well as sacral edema. Diffuse rales are present in all lung fields. He is afebrile and normotensive. A chest radiograph shows a markedly enlarged heart along with pulmonary edema and bilateral pleural effusions. He develops abdominal pain in the last two days of life. At autopsy he is found to have patchy mucosal erythema involving 200 cm of small intestine. Which of the following conditions is most likely to produce this finding in his bowel?

A Adenocarcinoma

B Venous thrombosis

C Volvulus

D Incarcerated hernia

E Ischemia
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Old 07-31-2011
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I am thinking E. ischemia..
Patient has CCF and hence the symptoms... ??!!
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Old 07-31-2011
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Ans E - Ischemia
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Old 08-01-2011
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Quote:
Originally Posted by mle2resident View Post
I am thinking E. ischemia..
Patient has CCF and hence the symptoms... ??!!
I think E. as well.
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Old 08-01-2011
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severe heart problem...im with ischemia
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Old 08-01-2011
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yea i'll go with e
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Old 08-01-2011
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E) ischemia caused by heart failure
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Old 08-02-2011
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Default Explanation

(A) Incorrect. Adenocarcinomas of the colon typically do not compromise circulation and do not produce ischemic enteritis.

(B) Incorrect. Venous thrombosis can occur in the presence of sepsis and hypercoagulable states, but it is a rare cause for ischemic bowel.

(C) Incorrect. Volvulus can cause ischemia, but it does not occur frequently, and it has an acute onset with bowel obstruction.

(D) Incorrect. An incarcerated hernia can cause ischemia in the segment of trapped bowel, but it is also likely to present as bowel obstruction.

(E) CORRECT. Hypotension with ischemia is probably the most common cause for ischemic enteritis and/or colitis. This man's heart disease (probably a dilated form of cardiomyopathy with both right and left-sided congestive heart failure) led to reduced cardiac output with reduced tissue perfusion. Though the bowel has a rich anastomosing blood supply, when flow is reduced in all branches, then ischemic can occur.
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