ROSH Gastrointestinal Practice Exam

Which condition is the most likely cause of lower abdominal pain and bloody diarrhea in an 82-year-old nursing-home resident?

1. Angiodysplasia

2. Diverticular bleeding

3. Ischemic colitis

4. Peptic ulcer disease

The correct answer is: Ischemic colitis

In the context of an 82-year-old nursing-home resident presenting with lower abdominal pain and bloody diarrhea, ischemic colitis is the most likely condition. This condition occurs when there is a reduction in blood flow to the colon, often due to underlying vascular issues that are more prevalent in older adults. Risk factors such as atherosclerosis, certain medications, and decreased blood flow can contribute to ischemic events, which lead to damage of the colonic mucosa and subsequent symptoms including abdominal pain and diarrhea that may be bloody. Older adults often exhibit these symptoms due to their increased susceptibility to vascular insufficiency and a slower overall physiological response to stressors compared to younger populations. Consequently, when considering lower abdominal pain with associated bloody diarrhea in this age group, ischemic colitis stands out as a common and critical diagnosis. Other conditions may cause similar symptoms but are less likely in this demographic or presentation. For instance, angiodysplasia typically presents with lower gastrointestinal bleeding without as prominent abdominal pain and is not necessarily linked to diarrhea. While diverticular bleeding is another potential cause of gastrointestinal bleeding, it is less commonly associated with diarrhea and more with volume blood loss into the stool. Peptic ulcer disease typically manifests with upper gastrointestinal symptoms and is characterized by epig