A 74-Year-Old Man Is Brought to the Emergency Department Due

question 428

Multiple Choice

A 74-year-old man is brought to the emergency department due to worsening lethargy and abdominal pain and distension.  For the past several days, the patient has had watery diarrhea.  However, in the last 24 hours, he has not had a bowel movement, and the abdominal pain and distension have worsened, with the patient becoming progressively more lethargic.  Medical history is significant for hypertension, myocardial infarction, atrial fibrillation, and stroke with hemiplegia.  He was recently hospitalized for treatment of an infected pressure ulcer.  Temperature is 38.8 C (101.8 F) , blood pressure is 106/60 mm Hg, and pulse is 118/min.  On physical examination, the patient is ill appearing and somnolent.  Mucous membranes are dry.  The abdomen is distended and diffusely tender.  Bowel sounds are decreased.  Leukocyte count is 18,000/mm³.  Serum potassium is 3.2 mEq/L.  Abdominal x-ray is shown in the image below: Which of the following is the most likely cause of this patient's current condition?

• A)Bacterial invasion and perforation of the bowel wall
• B)Electrolyte dysfunction causing ileus
• C)Entanglement of a bowel loop around fibrous bands
• D)Microbial toxin-induced colonic inflammation
• E)Sudden decrease in colonic perfusion pressure

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