Systemic pathology: ischaemic colitis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Systemic pathology: ischaemic colitis

Sample item

A 75-year-old man with atrial fibrillation has left iliac fossa pain and bloody diarrhoea after a hypotensive episode during surgery. Colonoscopy shows segmental mucosal necrosis at the splenic flexure with sparing of the rectum. Why is this site vulnerable?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. It is a watershed zone between the superior and inferior mesenteric territories

The splenic flexure is a watershed area between the superior and inferior mesenteric artery supplies, so it is most sensitive to hypoperfusion in low-flow states. The rectum is spared because of its dual supply from the internal iliac branches. Ischaemic colitis causes mucosal necrosis and may heal or stricture.

Option by option

  • A. It is a watershed zone between the superior and inferior mesenteric territories (correct)

    Correct. Low-flow states injure watershed zones such as the splenic flexure.

  • B. It has the poorest venous drainage through the portal vein

    Portal venous drainage is not the cause of segmental ischaemia at this site.

  • C. It receives its supply from the coeliac axis alone

    The coeliac axis supplies the foregut, not the splenic flexure.

  • D. It lies in the rectosigmoid with dual blood supply from the internal iliac arteries

    The rectosigmoid is protected by its dual supply and was spared in this case.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, It is a watershed zone between the superior and inferior mesenteric territories. The splenic flexure is a watershed area between the superior and inferior mesenteric artery supplies, so it is most sensitive to hypoperfusion in low-flow states.

Why is "It has the poorest venous drainage through the portal vein" not the answer?

Portal venous drainage is not the cause of segmental ischaemia at this site.

Why is "It receives its supply from the coeliac axis alone" not the answer?

The coeliac axis supplies the foregut, not the splenic flexure.

Why is "It lies in the rectosigmoid with dual blood supply from the internal…" not the answer?

The rectosigmoid is protected by its dual supply and was spared in this case.

What concept does this question test?

It tests Systemic pathology: ischaemic colitis in Pathology. The rectum is spared because of its dual supply from the internal iliac branches. Ischaemic colitis causes mucosal necrosis and may heal or stricture.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic pathology: ischaemic colitis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.