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An 83-Year-Old Man with Mild Cognitive Impairment Is Transported from an Assisted

Question 85

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An 83-year-old man with mild cognitive impairment is transported from an assisted living facility with a 2-day history of abdominal pain and decreased oral intake.  He has no vomiting, fever, or urinary symptoms.  He underwent coronary artery bypass grafting 6 years ago.  The patient also had a stent placed in his superficial femoral artery 3 years ago for claudication due to peripheral artery disease.
His temperature is 37.3° C (99.2° F) , blood pressure is 127/77 mm Hg, and pulse is 102/min.  He appears uncomfortable.  Examination shows dry membranes.  The abdomen is distended, diffusely tender, and tympanic to percussion.  There is no rebound tenderness or rigidity.
Laboratory results are as follows:
An 83-year-old man with mild cognitive impairment is transported from an assisted living facility with a 2-day history of abdominal pain and decreased oral intake.  He has no vomiting, fever, or urinary symptoms.  He underwent coronary artery bypass grafting 6 years ago.  The patient also had a stent placed in his superficial femoral artery 3 years ago for claudication due to peripheral artery disease. His temperature is 37.3° C (99.2° F) , blood pressure is 127/77 mm Hg, and pulse is 102/min.  He appears uncomfortable.  Examination shows dry membranes.  The abdomen is distended, diffusely tender, and tympanic to percussion.  There is no rebound tenderness or rigidity. Laboratory results are as follows: Contrast abdominal imaging, shown below, reveals a large, air-filled sigmoid colon with absence of air in the rectum. Which of the following is the best next step in managing this patient? A) Flexible sigmoidoscopy B) Nasogastric suction and broad-spectrum antibiotics C) Oral lactulose D) Sodium phosphate enema E) Surgery
Contrast abdominal imaging, shown below, reveals a large, air-filled sigmoid colon with absence of air in the rectum.
An 83-year-old man with mild cognitive impairment is transported from an assisted living facility with a 2-day history of abdominal pain and decreased oral intake.  He has no vomiting, fever, or urinary symptoms.  He underwent coronary artery bypass grafting 6 years ago.  The patient also had a stent placed in his superficial femoral artery 3 years ago for claudication due to peripheral artery disease. His temperature is 37.3° C (99.2° F) , blood pressure is 127/77 mm Hg, and pulse is 102/min.  He appears uncomfortable.  Examination shows dry membranes.  The abdomen is distended, diffusely tender, and tympanic to percussion.  There is no rebound tenderness or rigidity. Laboratory results are as follows: Contrast abdominal imaging, shown below, reveals a large, air-filled sigmoid colon with absence of air in the rectum. Which of the following is the best next step in managing this patient? A) Flexible sigmoidoscopy B) Nasogastric suction and broad-spectrum antibiotics C) Oral lactulose D) Sodium phosphate enema E) Surgery
Which of the following is the best next step in managing this patient?


A) Flexible sigmoidoscopy
B) Nasogastric suction and broad-spectrum antibiotics
C) Oral lactulose
D) Sodium phosphate enema
E) Surgery

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