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  #1  
Old 09-24-2011
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Default bright red blood per rectum

A 60-year-old woman with a history of diabetes and coronary artery disease comes to the emergency department complaining of acute onset of severe abdominal distress. In the ED, she begins passing bright-red blood per rectum. On examination, the abdomen is only mildly tender. Serum lactate is elevated. The diagnosis of ischemic colitis is made. The arteriogram seen here is found in the patient's records. Contrast in the arteriogram is seen in the distribution of which of the following?

A. Celiac trunk

B. External iliac artery

C. Inferior mesenteric artery

D. Internal iliac artery

E. Superior mesenteric artery

Kaplan q bank
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Old 09-24-2011
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A. Celiac trunk
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Old 09-24-2011
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The most susceptible part of the colon to ischemia would be splenic flexure, supplied by marginal artery which is an anastamosis of the two SMA and IMA. But if she passes red blood, i'd think that IMA is intact. So the contrast must be seen there. I choose C.
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Old 09-24-2011
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Quote:
Originally Posted by DocSikorski View Post
The most susceptible part of the colon to ischemia would be splenic flexure, supplied by marginal artery which is an anastamosis of the two SMA and IMA. But if she passes red blood, i'd think that IMA is intact. So the contrast must be seen there. I choose C.
Your point of view is right.
then why not celiac trunk ,ext illiac ,int illiac? they should be visualised .

I think thrombosis/embolism should be at higher level .
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Old 09-24-2011
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Quote:
Originally Posted by jaimin View Post
Your point of view is right.
then why not celiac trunk ,ext illiac ,int illiac? they should be visualised .

I think thrombosis/embolism should be at higher level .
yeah I saw yer post where u choose A and got confused. But then thought of what comes of aorta and on what level. Celiac trunc, SMA and IMA all leave aorta sepapartely. Trombosis would block the vessel. So to get the area of ischemic necrosis red (here is red bright blood goes outta rectum) u need a dual blood supply. SMA anasthamoses with IMA.

I am not sure if I am right with IMA answer its just my best guess.
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Old 09-24-2011
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Quote:
Originally Posted by ricko335 View Post
A 60-year-old woman with a history of diabetes and coronary artery disease comes to the emergency department complaining of acute onset of severe abdominal distress. In the ED, she begins passing bright-red blood per rectum. On examination, the abdomen is only mildly tender. Serum lactate is elevated. The diagnosis of ischemic colitis is made. The arteriogram seen here is found in the patient's records. Contrast in the arteriogram is seen in the distribution of which of the following?

A. Celiac trunk

B. External iliac artery

C. Inferior mesenteric artery

D. Internal iliac artery

E. Superior mesenteric artery

Kaplan q bank
C. ima splenic flexture is water shed area
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Old 09-24-2011
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i guess the answer is c
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Old 09-24-2011
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C is the best answer
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Old 09-24-2011
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Just checked Kaplan qbank.
This question has arteriogram given ,so answer should be given according to findings in arteriogram.

In picture Contrast is seen in branches of Inf mesentric artery ,so answer is Inferior mesentric.
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Old 09-25-2011
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C. Inferior mesenteric artery
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Old 09-25-2011
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the answer is inferior mesentric artery

Patients with ischemic colitis often have a history of abdominal angina or abdominal pain after eating. The arteriogram seen here has contrast in the distribution of the inferior mesenteric artery. The inferior mesenteric artery arises from the anterior aorta at the level of the body of L3, and gives rise to the left colic and sigmoid arteries before it terminates as the superior rectal artery. These branches supply the distal transverse colon, descending colon, and superior and mid rectum. The inferior mesenteric artery, as well as the left colic, sigmoid, and superior rectal branches can be seen here.

Last edited by ricko335; 09-25-2011 at 11:27 AM.
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Old 09-26-2011
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This is a really good quesion. Mesenteric infarcts can affect the celiac artery superior or inferior mesenteric arteries. The fact that the blood is bright red means that the source of bleeding is closest to the anus, thus inferior mesenteric artery is the answer.
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Old 09-26-2011
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this question is given with the image in the kaplan q bank. haha
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