{"id":9774,"date":"2026-04-29T00:02:13","date_gmt":"2026-04-29T08:02:13","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9774"},"modified":"2026-06-30T13:50:30","modified_gmt":"2026-06-30T21:50:30","slug":"usmle-step-1-question-of-the-day-gastrointestinal-ischemia","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gastrointestinal-ischemia","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Gastrointestinal ischemia"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gastrointestinal-ischemia\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gastrointestinal-ischemia\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gastrointestinal-ischemia\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gastrointestinal-ischemia\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gastrointestinal-ischemia\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-gastrointestinal-ischemia\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Today\u2019s USMLE\u00ae Step 1 question of the day features a 38-year-old woman following an accident involving blood loss, abdominal pain, and bloody stool. What&#8217;s the most likely diagnosis? Let&#8217;s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 38-year-old woman is brought to the emergency department following a motor vehicle accident. The patient\u2019s estimated <strong>blood loss is around 2 liters<\/strong>. A day later, she began experiencing <strong>crampy abdominal pain and multiple bloody bowel movements<\/strong>. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following regions of the gastrointestinal tract is at the most significant risk&nbsp;for&nbsp;ischemia?&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Stomach<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Duodenum<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Ileocecal junction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Descending colon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Rectosigmoid junction<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Rectosigmoid junction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Stomach<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The stomach receives extensive blood supply from branches of the celiac artery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Duodenum<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The duodenum receives extensive blood supply from branches of the celiac artery and superior mesenteric artery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Ileocecal junction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The ileocecal junction is where the small and large intestines meet. Branches of the superior mesenteric artery supply this region.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Descending colon<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The descending colon is supplied by branches of the inferior mesenteric artery.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has <strong>symptoms of ischemic colitis<\/strong> following a motor vehicle accident complicated by significant blood loss. Among the answer choices, <strong>the rectosigmoid junction is at the most critical risk of developing ischemia<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ischemia is the suppression or reduction of blood flow to an organ or tissue<\/strong>. The condition can arise due to decreased arterial perfusion (e.g., atherosclerosis, embolic stroke), impaired venous drainage (e.g., Budd-Chiari syndrome, testicular torsion), or shock.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watershed zones, <\/strong>which <strong>are areas of the body that receive dual blood supply from the most distal branches of two arteries, are highly vulnerable to ischemia in the setting of systemic hypoperfusion<\/strong>. By contrast, in cases of arterial occlusion (e.g. embolus obstructing one of the arteries), the watershed regions are spared mainly due to their dual blood supply. Examples of watershed regions include the intestinal splenic flexure and rectosigmoid junction, as well as the boundary areas between the brain&#8217;s anterior, middle, and posterior cerebral arteries.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>In addition to watershed zones, other areas of the body susceptible to ischemia include the liver&#8217;s and renal medulla&#8217;s centrilobular zone (since both regions have poor oxygen supply and high metabolic demands) as well as the left ventricular subendocardium (since it can be perfused only during diastole).<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ischemia describes suppressed or reduced blood flow to an organ or tissue.<\/strong> Regions of the body susceptible to ischemia include the watershed zones, centrilobular zone of the liver, renal medulla, and left ventricular subendocardium.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video: <a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_clinical_correlates:_Viscera_of_the_gastrointestinal_tract\">Anatomy clinical correlates: Viscera of the gastrointestinal tract<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Buckberg, G.D. (1977) <strong>Left ventricular subendocardial necrosis<\/strong>. The Annals of Thoracic Surgery. 24(4), 379-393. Doi: 10.1016\/s0003-4975(10)63418-2.<\/li>\n\n\n\n<li>Kalogeris, T., Baines, C.P., Krenz, M., Korthuis, R.J. (2016) <strong>Ischemia\/reperfusion. Comprehensive Physiology.<\/strong> 7(1), 113-170. Doi: 10.1002\/cphy.c160006.<\/li>\n\n\n\n<li>Ray, S.C., Mason, J., O\u2019Connor, P.M. (2019) <strong>Ischemic renal injury: Can renal anatomy and associated vascular congestion explain why the medulla and not the cortex is where the trouble starts?.<\/strong> Seminars in Nephrology. 39(6), 520-529. Doi: 10.1016\/j.semnephrol.2019.10.002.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"https:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/01\/Blog_Display_Ads_GENERAL2_2023.png?w=700\" alt=\"\" class=\"wp-image-4405\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/01\/Blog_Display_Ads_GENERAL2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/01\/Blog_Display_Ads_GENERAL2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-left wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1<\/strong> practice questions? Try <strong>Osmosis from Elsevier<\/strong> today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>&nbsp;and discover why millions of current and future <strong>clinicians <\/strong>and <strong>caregivers <\/strong>love <strong>learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Learn from this clinical case highlighting why certain gut regions are more vulnerable when perfusion drops, how watershed zones operate, and how clinicians use pathophysiology and reasoning to treat the issue.<\/p>\n","protected":false},"author":208,"featured_media":9776,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[1432,2815,489,2896,2894,2900,2895,84,2868,1435,2897,316,2899,2901,2898],"class_list":["post-9774","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-abdominal-pain","tag-case-study","tag-clinical-reasoning","tag-dual-blood-supply","tag-gastrointestinal-ischemia","tag-hypoperfusion","tag-ischemic-colitis","tag-medical-education","tag-nbme","tag-postoperative-complications","tag-radiology","tag-surgery","tag-trauma","tag-vascular-supply","tag-watershed-zones"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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