Gastroenterology and hepatology: ischaemic colitis: practice question

A General Medicine 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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General Medicine · Gastroenterology and hepatology: ischaemic colitis

Sample item

A 75-year-old woman with heart failure has sudden left-sided cramping abdominal pain followed within hours by bloody diarrhoea. CT shows segmental thickening of the splenic flexure with sparing of the rectum. Which explains the site of injury?

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

The answer and the reasoning

C. Watershed zone between superior and inferior mesenteric supply

Ischaemic colitis follows low flow in elderly patients with cardiac or vascular disease. The splenic flexure lies between the superior and inferior mesenteric territories and is vulnerable, while the rectum is protected by dual supply from the internal iliac vessels. Most cases settle with supportive care.

Option by option

  • A. Embolus to the superior mesenteric artery

    A superior mesenteric embolus causes small bowel and right colon infarction with severe pain.

  • B. Obstruction of the portal vein

    Portal vein obstruction leads to portal hypertension, not segmental colitis.

  • C. Watershed zone between superior and inferior mesenteric supply (correct)

    Correct. The splenic flexure is a watershed area, vulnerable to low flow.

  • D. Occlusion of the coeliac trunk

    Coeliac occlusion affects the foregut and is usually tolerated through collaterals.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Watershed zone between superior and inferior mesenteric supply. Ischaemic colitis follows low flow in elderly patients with cardiac or vascular disease.

Why is "Embolus to the superior mesenteric artery" not the answer?

A superior mesenteric embolus causes small bowel and right colon infarction with severe pain.

Why is "Obstruction of the portal vein" not the answer?

Portal vein obstruction leads to portal hypertension, not segmental colitis.

Why is "Occlusion of the coeliac trunk" not the answer?

Coeliac occlusion affects the foregut and is usually tolerated through collaterals.

What concept does this question test?

It tests Gastroenterology and hepatology: ischaemic colitis in General Medicine. The splenic flexure lies between the superior and inferior mesenteric territories and is vulnerable, while the rectum is protected by dual supply from the internal iliac vessels. Most cases settle with supportive care.

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 Gastroenterology and hepatology: ischaemic colitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.