08-19-2007, 10:39 AM
11. A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting for 24 hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after cardioversion to a normal sinus rhythm, she began treatment with warfarin. Yesterday at a follow-up visit, her INR was 6, and her medication was discontinued. She takes no other medications. Her temperature is 37 C (98.6 F), blood pressure is 100/78 mm Hg, pulse is 120/min and regular, and respirations are 20/min. The abdomen is distended and moderately tender; there is voluntary guarding in the epigastrium. There are no masses, organomegaly, or obvious hernias. Rectal examination shows no abnormalities. Test of the stool for occult blood is negative. Her hemoglobin level has decreased from 13 g/dL yesterday to 7.8 g/dL today. An ECG shows a normal sinus rhythm. Which of the following is the most likely explanation for this patient's abdominal symptoms?
A
) Internal small-bowel herniation
B
) Intestinal ischemia from a cardiac embolus
C
) Intramural hematoma of the proximal small bowel
D
) Intussusception of the small bowel
E
) Malrotation of the small bowel
NOT SURE THOUGH