HY USMLE Q #1130 – Gastro

An 84-year-old man is admitted to hospital for a 2-day history of severe generalized abdominal pain. He has long-standing type II diabetes managed with insulin. He is afebrile. Pulse is 100. Blood pressure is 110/75. Abdominal examination shows mild, diffuse tenderness to palpation. Serum studies show:

Sodium                                                                      140 mEq/L
Potassium                                                                4.2 mEq/L
Bicarbonate                                                            20 mEq/L

Abdominal CT shows thickening of the wall of the small bowel.
Which of the following is the next best step in management?

  Colonoscopy
  Dopamine
  Heparin
  Mesenteric angiography
  Operative management

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