Question

A 67-year-old man presents to the emergency department with abdominal pain. The patient states that whenever he eats he gets diffuse abdominal pain and experiences nausea, vomiting, and diarrhea. He states that the pain is mostly in the epigastric region. As a result of the pain, the patient has begun to eat less and has lost 10 pounds recently. The patient's past medical history is notable for diabetes, hypertension, dyslipidemia, and a 30 pack-year smoking history. His temperature is 99.2°F (37.3°C), blood pressure is 150/95 mmHg, pulse is 72/min, respirations are 16/min, and oxygen saturation is 100% on room air. Physical exam is notable for a nontender abdomen. The patient states that his abdominal pain mostly resolved by the time he arrived to the emergency department. Which of the following is the pathophysiology of the underlying diagnosis?

a. Atherosclerotic vessel narrowing
b. Common bile duct obstruction
c. Gastric mucosa erosion
d. Pancreatic enzyme activation
e. Thromboembolism

Answer 1

The diagnosis for the elderly man with postprandial abdominal pain and other gastrointestinal symptoms is likely chronic mesenteric ischemia caused by atherosclerotic vessel narrowing, aligning with his risk factors and resolving symptoms upon presentation.

Step-by-step explanation:

The pathophysiology of the underlying diagnosis for the 67-year-old man presenting with abdominal pain, nausea, vomiting, and weight loss after eating, mostly in the epigastric region, is most likely a. Atherosclerotic vessel narrowing. This condition, known as chronic mesenteric ischemia, occurs when the arteries that supply blood to the intestines are narrowed, leading to pain after eating (postprandial pain), weight loss, and gastrointestinal symptoms like those described. This patient's risk factors for atherosclerosis, such as diabetes, hypertension, dyslipidemia, and a smoking history, support this diagnosis.

Other options like common bile duct obstruction and pancreatic enzyme activation typically present with different symptoms and signs, such as jaundice or highly localized pain severity. Conversely, gastric mucosa erosion would generally be tender on examination, and thromboembolism would likely present acutely and not resolve without intervention.