Gastrointestinal Bleeding 301282.A 70-year-old woman presents to the ED with dark stool for 3 weeks.
She occasionally notes bright red blood mixed with the stool. Review of
systems is positive for decreased appetite, constipation, and a 10-lb weight
loss over 2 months. She denies abdominal pain, nausea, vomiting, and fever,
but feels increased weakness and fatigue. She also describes a raspy cough
with white sputum production over the previous 2 weeks. Examination
reveals a pale female with a supine BP of 115/60 mm Hg, HR of 90 beats
per minute. Standing BP is 100/50 mm Hg, with a pulse of 105 beats per
minute. Which of the following is the most likely diagnosis?
a. Hemorrhoids
b. Diverticulitis
c. Mallory-Weiss tear
d. Diverticulosis
e. Adenocarcinoma
283.A 76-year-old woman with a history of congestive heart failure, coronary
artery disease, and an “irregular heart beat” is brought to the ED by her
family. She has been complaining of increasing abdominal pain over the
past several days. She denies nausea or vomiting and bowel movements
remain unchanged. Vitals are HR of 114 beats per minute, BP 110/75 mm Hg,
and temperature 98°F. On cardiac examination, her HR is irregularly irreg-
ular with no murmur detected. The abdomen is soft, nontender, and nondis-
tended. The stool is heme-positive. This patient is at high risk for which of the
following conditions?
a. Perforated gastric ulcer
b. Diverticulitis
c. Acute cholecystitis
d. Mesenteric ischemia
e. Sigmoid volvulus