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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal, Genitourinary, General Principles
|SubCategory=Gastrointestinal, Genitourinary, General Principles
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Gastrointestinal, Genitourinary, General Principles
|SubCategory=Gastrointestinal, Genitourinary, General Principles
|Prompt=A 69 year old women with a past medical history significant for coronary artery disease, peripheral vascular disease, heart failure, and atrial fibrillation presents to the emergency department (ED) in excruciating abdominal pain that started several minutes before admission. Physical examination is unremarkable; the abdomen is nontender, no masses or hepatosplenomegaoy are appreciated. The patient undergoes computed tomography (CT) angiography and the diagnosis of occlusive acute mesenteric ischemia of the superior mesenteric artery (SMA) is made. Urgent laparotomy shows infarcts of specific abdominal regions. Which of the following organs most likely has a similar gross pathological appearance when infarcted?
|Prompt=A 69-year-old woman with a past medical history significant for coronary artery disease, peripheral vascular disease, heart failure, and atrial fibrillation presents to the emergency department for severe abdominal pain that started several minutes before admission. Physical examination is grossly unremarkable. The abdomen is nontender and no masses or hepatosplenomegaly could be appreciated. The patient undergoes CT angiography and the diagnosis of occlusive acute mesenteric ischemia of the superior mesenteric artery (SMA) is made. Urgent laparotomy shows significant small bowel infarcts. Which of the following organs most likely has a similar gross pathological appearance when infarcted?
|Explanation=The patient has mesenteric ischemia that most likely progressed to mesenteric infarction. It is considered an emergency, whereby patients are usually older than 60 years with a prominent cardiovascular past medical history, such as heart failure, myocardial infarction, and arrhythmias that predispose them to arterial embolization to the superior mesenteric arteries. As seen in this patient, physical examination in mesenteric ischemia is usually unremarkable and interestingly contradicts the patient's symptoms. The patients typically complain of excruciating pain but no tenderness on physical examination. CT angiography is currently widely used for the diagnosis of acute mesenteric ischemia. Laparotomy is especially indicated when peritoneal symptoms are present and when infarction is suspected, but it is performed anyways in almost all cases of acute mesenteric ischemia.  
|Explanation=The patient in this scenario has [[mesenteric ischemia]] that most likely progressed to mesenteric [[infarction]]. Acute mesenteric ischemia is considered a medical emergency. Patients are classically older than 60 years of age with a prominent cardiovascular past medical history, such as [[heart failure]], [[myocardial infarction]], and [[arrhythmias]] that predispose them to arterial [[embolization]] to the mesenteric arteries. Physical examination in early mesenteric ischemia is usually unremarkable and interestingly contradicts the patient's symptoms. The patients typically complain of excruciating pain but little or no tenderness can be appreciated on physical examination. CT angiography is currently the gold standard for the diagnosis of acute mesenteric ischemia. Laparotomy is especially indicated when peritoneal symptoms are present and when infarction is suspected.
 
Bowel ischemia is called red (hemorrhagic) ischemia, similar to that seen in loose tissues that contain dual circulations such as the lungs, and small intestine, in venous occlusion such as that seen in ovarian and testicular torsions, and in loose tissues such as the lung. On the other hand, white (pale or anemic) ischemia is characteristic of solid organs that contain end arterial circulation such as the heart, kidney, and spleen


Educational Objective: Lung, liver, bowels, ovaries, and testes undergo red (hemorrhagic) infarction.
Bowel ischemia is called red (hemorrhagic) ischemia, similar to that seen in loose tissues that contain dual circulations such as the lungs, and small intestine, in venous occlusion such as that seen in ovarian and testicular torsions, and in loose tissues such as the lung. On the other hand, white (pale or anemic) ischemia is characteristic of solid organs that contain end arterial circulation such as the heart, kidney, and spleen.
|AnswerA=Testis
|AnswerA=Testis
|AnswerAExp=Testes and ovaries undergo red (hemorrhagic) infarction.
|AnswerAExp=Testes and ovaries undergo red (hemorrhagic) infarction.
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|AnswerD=Spleen
|AnswerD=Spleen
|AnswerDExp=Heart, kidney, and spleen undergo white (pale or anemic) infarction.
|AnswerDExp=Heart, kidney, and spleen undergo white (pale or anemic) infarction.
|AnswerE=Kidney capsule
|AnswerE=Kidney cortex
|AnswerEExp=Heart, kidney, and spleen undergo white (pale or anemic) infarction.
|AnswerEExp=Heart, kidney, and spleen undergo white (pale or anemic) infarction.
|EducationalObjectives=Lung, liver, bowels, ovaries, and testes undergo red (hemorrhagic) infarction.
|References=Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology. Chapter 3: Hemodynamic Disorders, Thromboembolism, and Shock. Elsevier Health Sciences; 2012.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=infarct, infarction, white, red, pale, anemic, hemorrhagic, mesenteric, ischemia, laparotomy
|WBRKeyword=Infarct, Red infarction, White infarction, Hemorrhagic, Mesenteric ischemia, Superior mesenteric artery
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:22, 28 October 2020
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Gastrointestinal, SubCategory::Genitourinary, SubCategory::General Principles
Prompt [[Prompt::A 69-year-old woman with a past medical history significant for coronary artery disease, peripheral vascular disease, heart failure, and atrial fibrillation presents to the emergency department for severe abdominal pain that started several minutes before admission. Physical examination is grossly unremarkable. The abdomen is nontender and no masses or hepatosplenomegaly could be appreciated. The patient undergoes CT angiography and the diagnosis of occlusive acute mesenteric ischemia of the superior mesenteric artery (SMA) is made. Urgent laparotomy shows significant small bowel infarcts. Which of the following organs most likely has a similar gross pathological appearance when infarcted?]]
Answer A AnswerA::Testis
Answer A Explanation AnswerAExp::Testes and ovaries undergo red (hemorrhagic) infarction.
Answer B AnswerB::Heart
Answer B Explanation AnswerBExp::Heart, kidney, and spleen undergo white (pale or anemic) infarction.
Answer C AnswerC::Kidney medulla
Answer C Explanation AnswerCExp::Heart, kidney, and spleen undergo white (pale or anemic) infarction.
Answer D AnswerD::Spleen
Answer D Explanation AnswerDExp::Heart, kidney, and spleen undergo white (pale or anemic) infarction.
Answer E AnswerE::Kidney cortex
Answer E Explanation AnswerEExp::Heart, kidney, and spleen undergo white (pale or anemic) infarction.
Right Answer RightAnswer::A
Explanation [[Explanation::The patient in this scenario has mesenteric ischemia that most likely progressed to mesenteric infarction. Acute mesenteric ischemia is considered a medical emergency. Patients are classically older than 60 years of age with a prominent cardiovascular past medical history, such as heart failure, myocardial infarction, and arrhythmias that predispose them to arterial embolization to the mesenteric arteries. Physical examination in early mesenteric ischemia is usually unremarkable and interestingly contradicts the patient's symptoms. The patients typically complain of excruciating pain but little or no tenderness can be appreciated on physical examination. CT angiography is currently the gold standard for the diagnosis of acute mesenteric ischemia. Laparotomy is especially indicated when peritoneal symptoms are present and when infarction is suspected.

Bowel ischemia is called red (hemorrhagic) ischemia, similar to that seen in loose tissues that contain dual circulations such as the lungs, and small intestine, in venous occlusion such as that seen in ovarian and testicular torsions, and in loose tissues such as the lung. On the other hand, white (pale or anemic) ischemia is characteristic of solid organs that contain end arterial circulation such as the heart, kidney, and spleen.
Educational Objective: Lung, liver, bowels, ovaries, and testes undergo red (hemorrhagic) infarction.
References: Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology. Chapter 3: Hemodynamic Disorders, Thromboembolism, and Shock. Elsevier Health Sciences; 2012.]]

Approved Approved::Yes
Keyword WBRKeyword::Infarct, WBRKeyword::Red infarction, WBRKeyword::White infarction, WBRKeyword::Hemorrhagic, WBRKeyword::Mesenteric ischemia, WBRKeyword::Superior mesenteric artery
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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