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Ischaemic bowel — SCE Acute Medicine MCQ

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ModerateAcute GI PresentationsIschaemic bowelSCE Acute Medicine

A 76-year-old woman is assessed on the acute medical unit. She has atrial fibrillation and severe abdominal pain out of proportion to examination. Lactate is 6.2 mmol/L and metabolic acidosis is present. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: C — CT abdomen and pelvis with contrast

CT abdomen and pelvis with contrast is the best answer because pain out of proportion with raised lactate suggests mesenteric ischaemia requiring urgent contrast CT. Urgent upper gastrointestinal endoscopy is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: A normal early abdominal examination does not exclude bowel ischaemia.

Reference: WSES acute mesenteric ischaemia guideline