A 62-year-old man who is a chronic smoker with a history of widespread atherosclerotic vascular disease complains of a 3-h history of severe midabdominal pain, accompanied by nausea and vomiting. He has a history of myocardial ischemia and peripheral vascular disease. On examination, he is writhing in pain. His abdomen has normal bowel sounds and minimal tenderness. A small amount of blood is present in the stool specimen. The electrolytes show a low bicarbonate level at 15 mEq/L, and the serum lactate level is high, which are indicative of tissue receiving insufficient oxygenation leading to tissue injury. A surgeon, who is concerned about mesenteric ischemia, has been called to evaluate the patient. Which of the following is the most likely diagnosis? Appendicitis Cholecystitis Gastritis Superior mesenteric thrombosis Amebic colitis
A 62-year-old man who is a chronic smoker with a history of widespread atherosclerotic vascular disease complains of a 3-h history of severe midabdominal pain, accompanied by nausea and vomiting. He has a history of myocardial ischemia and peripheral vascular disease. On examination, he is writhing in pain. His abdomen has normal bowel sounds and minimal tenderness. A small amount of blood is present in the stool specimen. The electrolytes show a low bicarbonate level at 15 mEq/L, and the serum lactate level is high, which are indicative of tissue receiving insufficient oxygenation leading to tissue injury. A surgeon, who is concerned about mesenteric ischemia, has been called to evaluate the patient. Which of the following is the most likely diagnosis?
- Appendicitis
- Cholecystitis
- Gastritis
- Superior mesenteric thrombosis
- Amebic colitis
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