Question

A 61-year-old man presents to his primary care provider complaining of abdominal pain and constipation. He reports a 4-day history of steady right lower quadrant pain. He has had one small bowel movement in 4 days. Normally he has a bowel movement once a day. His medical history is notable for poorly controlled hypertension and hyperlipidemia. He takes enalapril, hydrochlorothiazide, aspirin, and atorvastatin. He has a 40 pack-year smoking history and drinks 3-4 beers per day. His diet consists primarily of fast food. His temperature is 101.8°F (38.8°C), blood pressure is 160/95 mmHg, pulse is 90/min, and respirations are 16/min. A review of the patient's medical record reveals colonoscopy results from 1 year ago. Relevant findings included multiple small, pedunculated polyps which were removed, multiple colonic mucosal outpouchings, and no other masses. This patient's condition is most strongly associated with which of the following disorders?

a. Alpha-1-antitrypsin deficiency
b. Autosomal recessive polycystic kidney disorder
c. Ehlers-Danlos syndrome
d. Goodpasture syndrome
e. Menetrier disease

Answer 1

The patient's symptoms and colonoscopy findings of multiple colonic mucosal outpouchings are most indicative of diverticular disease of the colon, especially given the presence of fever and location of abdominal pain.

Step-by-step explanation:

The condition described in this patient's case, marked by right lower quadrant pain, constipation, and the presence of multiple colonic mucosal outpouchings noted in a prior colonoscopy, is most strongly associated with diverticular disease of the colon. These symptoms, coupled with the fact that colonoscopy results show multiple colonic mucosal outpouchings, are indicative of the complications associated with this condition. The fever indicates an ongoing infection which, in the context of diverticular disease, suggests diverticulitis.

Options a, b, c, d, and e (Alpha-1-antitrypsin deficiency, Autosomal recessive polycystic kidney disorder, Ehlers-Danlos syndrome, Goodpasture syndrome, Menetrier disease) do not fit the symptoms and colonoscopy findings described. Although the history of smoking, alcohol consumption, and poor diet may contribute to various health issues, they do not directly indicate these disorders in relation to the symptoms and findings detailed in the patient's record.