A 56-Year-Old Man Is Admitted to the Intensive Care Unit

A 56-year-old man is admitted to the intensive care unit due to septic shock from pneumonia and is treated with intravenous fluids, antibiotics, and vasopressors.  Four days later, the patient's hemodynamic and respiratory status has improved, but he has worsening anemia with positive stool occult blood.  He has had no abdominal pain, nausea, vomiting, hematemesis, diarrhea, or hematochezia.  Medical history includes hypertension but no prior gastrointestinal disorders.  The patient is a smoker with a 40-pack-year history.  Medications are intravenous ceftriaxone and azithromycin.  Temperature is 37.2 C (99 F) , blood pressure is 110/66 mm Hg, and pulse is 84/min.  Physical examination reveals right lung crackles and no abdominal tenderness.  Hemoglobin is 10.2 g/dL (12.6 g/dL at admission) , platelets are 180,000/mm³, and leukocytes are 12,000/mm³.  Which of the following is the most likely cause of this patient's anemia?

A) Acute colonic ischemia
B) Acute infectious colitis
C) Diverticular bleeding
D) Peptic ulcer disease
E) Stress-induced ulcer

Correct Answer:

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