Alternative PANRE Test Question: Acute Onset Abdominal Pain

A 76-year-old woman presents with acute onset of periumbilical abdominal pain three hours ago. Her past medical history is significant for hypertension and peripheral artery disease. An echocardiogram performed three months ago showed left ventricular ejection fraction of 38%.

She states she is severely nauseous and has vomited four times, as well as having three bowel movements since onset. Her physical examination of her abdomen is non-revealing. She has no rebound tenderness, no specific point tenderness, no palpable splenomegaly or hepatomegaly. She does have heme positive stool in the vault.

What is the most appropriate diagnosis?

A. Acute kidney injury
B. Acute mesenteric ischemia
C. Congestive heart failure
D. Crohn’s disease
E. Diverticulitis