284.A 70-year-old woman with a history of hypertension, congestive
heart failure, and atrial fibrillation presents to the ED with several hours of
acute onset diffuse abdominal pain. She denies any nausea or vomiting.
The pain is constant but she is unable to localize it. She was diagnosed with
a renal artery thrombosis several years ago. Vital signs include HR of 95 beats
per minute, BP of 110/70 mm Hg, and temperature of 98°F. Her abdomen
is soft and mildly tender, despite her reported severe abdominal pain. Her
WBC count is 12,000/μL, hematocrit 38%, platelets 250/μL, and lactate
8 mg/dL. The stool is trace heme-positive. You are concerned for acute
mesenteric ischemia. What is the best way to diagnose this condition?
a. Serum lactate levels
b. Abdominal radiograph (supine and upright)
c. CT scan
d. Angiography
e. Barium contrast study
285.A 55-year-old man with hypertension and end-stage renal disease
requiring hemodialysis presents with 2 days of painless hematochezia. He
reports similar episodes of bleeding in the past, which were attributed to
angiodysplasia. He denies abdominal pain, nausea, vomiting, diarrhea, and
fever. His vitals include HR of 90 beats per minute, BP of 145/95 mm Hg, RR
of 18 breaths per minute, and temperature of 98°F. His abdomen is soft and
nontender and his stool is grossly positive for blood. Which of the following
statements are true regarding angiodysplasia?
a. They are responsible for over 50% of acute lower GI bleeding.
b. They are more common in younger patients.
c. Angiography is the most sensitive method for identifying angiodysplasias.
d. They are less common in patients with end-stage renal disease.
e. The majority of angiodysplasias are located on the right side of the colon.
302 Emergency Medicine